MEDICARE: MR. SIMON T GARZA JR.

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	207Q00000X	Family Medicine Physician	J9042	TX

General Provider Information

NPI Number	:	1447414081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SIMON T GARZA JR.

Provider Business Mailing Address
First Line	:	11703 HUEBNER RD
Second Line	:	SUITE # 106298
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-1201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11703 HUEBNER RD
Second Line	:	SUITE # 106298
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-1201
Country	:	US
Telephone Number	:	210-365-5888
Fax Number	:	210-697-1828

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

Provider Enumeration Date	:	07/14/2008
Last Update Date	:	07/14/2008

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