Healthcare Provider Details

I. General information

NPI: 1053873190
Provider Name (Legal Business Name): JOSE MISAEL GARCIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: J. MISAEL GARCIA MD

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 SPURS LN STE 240
SAN ANTONIO TX
78240-1671
US

IV. Provider business mailing address

21 SPURS LN STE 240
SAN ANTONIO TX
78240-1671
US

V. Phone/Fax

Practice location:
  • Phone: 210-690-0777
  • Fax: 210-696-6376
Mailing address:
  • Phone: 210-690-0777
  • Fax: 210-696-6376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberT3953
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: