Provider Demographics
NPI:1518131523
Name:GARZA, JAIME R (MD)
Entity Type:Individual
Prefix:MR
First Name:JAIME
Middle Name:R
Last Name:GARZA
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 1:21 SPURS LN
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1669
Mailing Address - Country:US
Mailing Address - Phone:210-616-0301
Mailing Address - Fax:
Practice Address - Street 1:21 SPURS LN
Practice Address - Street 2:SUITE 120
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1669
Practice Address - Country:US
Practice Address - Phone:210-616-0301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH49262086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00457XMedicare PIN
TXC16002Medicare UPIN