Provider Demographics
NPI:1891773305
Name:GARZA-TAMEZ, JESUS M (MD)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:M
Last Name:GARZA-TAMEZ
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 1:2102 TREASURE HILLS BLVD.
Mailing Address - Street 2:#3.144.11
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8736
Mailing Address - Country:US
Mailing Address - Phone:956-296-1437
Mailing Address - Fax:956-296-6842
Practice Address - Street 1:205 E TORONTO AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1209
Practice Address - Country:US
Practice Address - Phone:956-687-6155
Practice Address - Fax:956-631-8063
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8164207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0965824-06Medicaid
TX096582402Medicaid
TX0088ENOtherBC BS
TX00BF19OtherFMC BCBS GROUP
TX00388LMedicare PIN
TX00BF19OtherFMC BCBS GROUP
TX321792ZK0DMedicare PIN