Provider Demographics
NPI:1417180142
Name:RENDON GARCIA, JUAN JESUS (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:JESUS
Last Name:RENDON 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 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:956-631-0393
Mailing Address - Fax:956-682-4689
Practice Address - Street 1:1801 S 5TH ST STE 207
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-2932
Practice Address - Country:US
Practice Address - Phone:956-631-0393
Practice Address - Fax:956-682-4689
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP34232086S0102X, 2086S0127X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8DK720OtherBCBS TX
TX309697601Medicaid
TXTXB166177Medicare PIN