Provider Demographics
NPI:1750375150
Name:GARCIA, ELENA (MD)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 MEDICAL CENTER BLVD
Mailing Address - Street 2:STE. 100
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2809
Mailing Address - Country:US
Mailing Address - Phone:936-788-1060
Mailing Address - Fax:936-788-2844
Practice Address - Street 1:503 MEDICAL CENTER BLVD
Practice Address - Street 2:STE 100
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2809
Practice Address - Country:US
Practice Address - Phone:936-788-1060
Practice Address - Fax:936-788-2844
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1050207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080191575OtherRAILROAD MEDICARE
TX150961401Medicaid
TX037714502Medicaid
TX8G0690OtherBLUE CROSS BLUE SHIELD
TX080191575OtherRAILROAD MEDICARE
H30501Medicare UPIN
8956NIMedicare ID - Type Unspecified