Provider Demographics
NPI:1558406116
Name:GARZA, ISAIAS JR (MD)
Entity Type:Individual
Prefix:
First Name:ISAIAS
Middle Name:
Last Name:GARZA
Suffix:JR
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 1:1516 DEMARET CT
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-7542
Mailing Address - Country:US
Mailing Address - Phone:956-334-0477
Mailing Address - Fax:956-441-1650
Practice Address - Street 1:1516 DEMARET CT
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-7542
Practice Address - Country:US
Practice Address - Phone:956-334-0477
Practice Address - Fax:956-441-1650
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1087207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121506301Medicaid
TX742434164OtherPRIVATE INSURANCE
TX121506303OtherMEDICAID EPSDT
TX742434164OtherPRIVATE INSURANCE
TX121506301Medicaid