Healthcare Provider Details

I. General information

NPI: 1750463923
Provider Name (Legal Business Name): JORGE DE LA GARZA, M.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 12/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 LINDBERG AVE
MCALLEN TX
78501-2920
US

IV. Provider business mailing address

PO BOX 720385
MCALLEN TX
78504-0385
US

V. Phone/Fax

Practice location:
  • Phone: 956-971-0066
  • Fax: 956-971-0072
Mailing address:
  • Phone: 956-971-0066
  • Fax: 956-971-0072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberG3280
License Number StateTX

VIII. Authorized Official

Name: DR. JORGE LUIS DE LA GARZA
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 956-971-0066