Provider Demographics
NPI:1760445381
Name:GARCIA, JUAN MARCOS (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:MARCOS
Last Name:GARCIA
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 1:512 VICTORIA LANE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550
Mailing Address - Country:US
Mailing Address - Phone:956-428-3702
Mailing Address - Fax:956-428-2352
Practice Address - Street 1:512 VICTORIA LN
Practice Address - Street 2:SUITE 7
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-3226
Practice Address - Country:US
Practice Address - Phone:956-428-3702
Practice Address - Fax:956-428-2352
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9582207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00042BQ2Medicaid
TX130868604Medicaid
TX0042BQMedicare PIN
TX130868604Medicaid
TXP00042BQ2Medicaid
TX8F21649Medicare PIN