Provider Demographics
NPI:1285662502
Name:GARCIA, JOHN S (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100104
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-1404
Mailing Address - Country:US
Mailing Address - Phone:210-222-2001
Mailing Address - Fax:210-222-2254
Practice Address - Street 1:730 N MAIN AVE
Practice Address - Street 2:824
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-1152
Practice Address - Country:US
Practice Address - Phone:210-222-2001
Practice Address - Fax:210-222-2254
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3105207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121165802Medicaid
TX00N81ZOtherBCBSTX
TXA48164Medicare UPIN
TX00N81ZMedicare PIN