Provider Demographics
NPI:1710287966
Name:MARTHA MARIE GARZA MD PA
Entity Type:Organization
Organization Name:MARTHA MARIE GARZA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-614-3352
Mailing Address - Street 1:4499 MEDICAL DR
Mailing Address - Street 2:STE. 151
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3735
Mailing Address - Country:US
Mailing Address - Phone:210-614-3352
Mailing Address - Fax:210-614-0945
Practice Address - Street 1:4499 MEDICAL DR
Practice Address - Street 2:STE. 151
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3735
Practice Address - Country:US
Practice Address - Phone:210-614-3352
Practice Address - Fax:210-614-0945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3384207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098243102Medicaid
00F23DOtherMEDICARE PTAN