Healthcare Provider Details

I. General information

NPI: 1477530350
Provider Name (Legal Business Name): RICHARD PROCTOR GARZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 W 34TH ST
AUSTIN TX
78705-2009
US

IV. Provider business mailing address

8240 N MOPAC EXPY STE 100
AUSTIN TX
78759-8869
US

V. Phone/Fax

Practice location:
  • Phone: 512-687-1950
  • Fax: 512-687-1490
Mailing address:
  • Phone: 512-687-1950
  • Fax: 512-407-9010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberN0779
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: