MEDICARE: WILSON J. GARCIA, M.D. , P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	E4845	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1922030766	OTHER		NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295064830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILSON J. GARCIA, M.D. , P.A.

Provider Business Mailing Address
First Line	:	1201 5TH AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4304
Country	:	US
Telephone Number	:	817-332-2784
Fax Number	:	817-338-9014

Provider Business Practice Location Address
First Line	:	1201 5TH AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4304
Country	:	US
Telephone Number	:	817-332-2784
Fax Number	:	817-338-9014

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WILSON J GARCIA
Credential	:	M.D.
Telephone Number	:	817-332-2784

Provider Enumeration Date	:	12/10/2009
Last Update Date	:	04/01/2010

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