Provider Demographics
NPI:1639188501
Name:GARCIA, RUBEN LUIS JR (MD)
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:LUIS
Last Name:GARCIA
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 1:1701 SOUTH PALESTINE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-5739
Mailing Address - Country:US
Mailing Address - Phone:903-675-9339
Mailing Address - Fax:903-675-9344
Practice Address - Street 1:1701 SOUTH PALESTINE
Practice Address - Street 2:SUITE A
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-5739
Practice Address - Country:US
Practice Address - Phone:903-675-9339
Practice Address - Fax:903-675-9344
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9465174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4408768OtherAETNA
TX8856N0OtherMEDICARE
TX8856N0OtherBCBS
TX0997686-01Medicaid
TX340007216OtherRAILROAD MEDICARE
TX0997686-01Medicaid