MEDICARE: DR. MARGARITA DE LA GARZA-GRAHM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	J1225	TX

General Provider Information

NPI Number	:	1083686877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARGARITA DE LA GARZA-GRAHM MD

Provider Business Mailing Address
First Line	:	1020 E LAKE ST
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-2033
Country	:	US
Telephone Number	:	903-593-5500
Fax Number	:	903-593-5408

Provider Business Practice Location Address
First Line	:	1020 E LAKE ST
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-2033
Country	:	US
Telephone Number	:	903-593-5500
Fax Number	:	903-593-5408

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	07/08/2007

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