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General NPI Number Information
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NPI Number | 1295064830
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Entity Type | Organization
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Legal Business Name | WILSON J. GARCIA, M.D. , P.A.
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Dates
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Enumeration Date | 12/10/2009
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Last Update Date | 04/01/2010
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Provider Practice Location Address
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Address Line | 1201 5TH AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-4304
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Country | US
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Telephone | 817-332-2784
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Fax | 817-338-9014
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Provider Business Mailing Address
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Address Line | 1201 5TH AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-4304
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Country | US
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Telephone | 817-332-2784
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Fax | 817-338-9014
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILSON J GARCIA
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Credential | M.D.
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Telephone | 817-332-2784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | E4845
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License Number State | TX
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