Basic Information
| Provider Information | |||||||||
| NPI: | 1629062039 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARCIA | ||||||||
| FirstName: | GILBERT | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 E. MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | HUMBLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2815487334 | ||||||||
| FaxNumber: | 2815487363 | ||||||||
| Practice Location | |||||||||
| Address1: | 104 E. MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | HUMBLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2815487334 | ||||||||
| FaxNumber: | 2815487363 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2005 | ||||||||
| LastUpdateDate: | 07/15/2015 | ||||||||
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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 | 208000000X | K1197 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 092312001 | 05 | TX | MEDICAID | 760597463 | 01 | TX | COMMERICAL | OTHER | 092312002 | 05 | TX | MEDICAID |