Basic Information
| Provider Information | |||||||||
| NPI: | 1528043312 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARZA | ||||||||
| FirstName: | DANTE | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2624 | ||||||||
| Address2: | |||||||||
| City: | VICTORIA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779022624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3615763680 | ||||||||
| FaxNumber: | 3615764219 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 E SAN ANTONIO ST | ||||||||
| Address2: | SUITE 102 W | ||||||||
| City: | VICTORIA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779016004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3615764164 | ||||||||
| FaxNumber: | 3615764219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2005 | ||||||||
| LastUpdateDate: | 10/25/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MDL3970 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0087JG | 01 | TX | BCBS OF TX # | OTHER | 8AG481 | 01 | TX | BCBS OF TX | OTHER |