MEDICARE: RAFAEL ROBERTO GARCIA 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	208000000X	Pediatrics Physician	F8488	TX

General Provider Information

NPI Number	:	1265526636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAFAEL ROBERTO GARCIA MD

Provider Business Mailing Address
First Line	:	2100 N MAIN ST
Second Line	:	SUITE 107
City	:	FORT WORTH
State	:	TX
Zip	:	76164-8570
Country	:	US
Telephone Number	:	817-625-4254
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 N MAIN ST
Second Line	:	SUITE 107
City	:	FORT WORTH
State	:	TX
Zip	:	76164-8570
Country	:	US
Telephone Number	:	817-625-4254
Fax Number	:

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	02/28/2014

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