Provider Demographics
NPI:1760476188
Name:GOLETZ, TY HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:TY
Middle Name:HENRY
Last Name:GOLETZ
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:PO BOX 1038
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78294-1038
Mailing Address - Country:US
Mailing Address - Phone:210-692-7400
Mailing Address - Fax:210-692-0090
Practice Address - Street 1:7940 FLOYD CURL DR
Practice Address - Street 2:SUITE 560
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3905
Practice Address - Country:US
Practice Address - Phone:210-692-7400
Practice Address - Fax:210-692-0090
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1409174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1780897306OtherGROUP NPI
TX047686301Medicaid
TXC16219Medicare UPIN
TX047686301Medicaid
TX8990K1Medicare PIN