MEDICARE: MARK GARZA, M.D., PLLC

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	207QS0010X	Sports Medicine (Family Medicine) Physician
2	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1528603495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK GARZA, M.D., PLLC

Provider Business Mailing Address
First Line	:	PO BOX 23436
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4485
Country	:	US
Telephone Number	:	817-294-0934
Fax Number	:	817-294-1488

Provider Business Practice Location Address
First Line	:	209 SAINT LOUIS AVE STE 100
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-1231
Country	:	US
Telephone Number	:	817-294-0934
Fax Number	:	817-294-1488

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	LORI A PAYNE
Credential	:
Telephone Number	:	817-953-2968

Provider Enumeration Date	:	11/14/2019
Last Update Date	:	11/14/2019

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