Provider Demographics
NPI:1447414081
Name:GARZA, SIMON T JR
Entity Type:Individual
Prefix:MR
First Name:SIMON
Middle Name:T
Last Name:GARZA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SIMON
Other - Middle Name:T
Other - Last Name:GARZA-KEEVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:11703 HUEBNER RD
Mailing Address - Street 2:SUITE # 106298
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11703 HUEBNER RD
Practice Address - Street 2:SUITE # 106298
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1201
Practice Address - Country:US
Practice Address - Phone:210-365-5888
Practice Address - Fax:210-697-1828
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9042207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine