Healthcare Provider Details

I. General information

NPI: 1821072323
Provider Name (Legal Business Name): JUAN GARZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WILFORD HALL LOOP, BLDG 4554 ATTN: 59 MDW/SGHC
JBSA LACKLAND TX
78236
US

IV. Provider business mailing address

1100 WILFORD HALL LOOP, BLDG 4554 ATTN: 59 MDW/SGHC
JBSA LACKLAND TX
78236-9908
US

V. Phone/Fax

Practice location:
  • Phone: 210-292-6225
  • Fax: 210-292-7868
Mailing address:
  • Phone: 210-292-6225
  • Fax: 210-292-7868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number023976
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number023976
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number023976
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: