Provider Demographics
NPI:1922007285
Name:DE LA GARZA, DAVID J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:DE LA GARZA
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 1:3435 NE LOOP 286
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-5002
Mailing Address - Country:US
Mailing Address - Phone:903-737-0000
Mailing Address - Fax:903-785-1135
Practice Address - Street 1:3435 NE LOOP 286
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-5002
Practice Address - Country:US
Practice Address - Phone:903-737-0000
Practice Address - Fax:903-785-1135
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8109207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1436404-01Medicaid
OK100161570AMedicaid
TX1436404-01Medicaid
H36604Medicare UPIN