Provider Demographics
NPI:1295742146
Name:GARCIA-DAVALOS, JOSE N (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:N
Last Name:GARCIA-DAVALOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6416 POLARIS DR STE 1B
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2089
Mailing Address - Country:US
Mailing Address - Phone:956-791-7100
Mailing Address - Fax:956-791-0144
Practice Address - Street 1:6416 POLARIS DR STE 1B
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2089
Practice Address - Country:US
Practice Address - Phone:956-791-7100
Practice Address - Fax:956-791-0144
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF3131207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00G65EOtherBLUE CROSS BLUE SHIELD
TX742595954OtherTAX ID
TX130372907Medicaid
TXE77996Medicare UPIN
TX742595954OtherTAX ID
TX00588FMedicare ID - Type Unspecified