=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659417285
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POTENCIANO R. GARCIA, JR. M.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4903 N MCCOLL RD
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78504-2310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-631-5864
-----------------------------------------------------
Fax | 956-631-5880
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4876
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78502-4876
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-631-5864
-----------------------------------------------------
Fax | 956-631-5880
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | POTENCIANO R. GARCIA JR.
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 956-631-5864
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | G7214
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------