Basic Information
Provider Information | |||||||||
NPI: | 1891773305 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GARZA-TAMEZ | ||||||||
FirstName: | JESUS | ||||||||
MiddleName: | M | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2102 TREASURE HILLS BLVD. | ||||||||
Address2: | #3.144.11 | ||||||||
City: | HARLINGEN | ||||||||
State: | TX | ||||||||
PostalCode: | 785508736 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9562961437 | ||||||||
FaxNumber: | 9562966842 | ||||||||
Practice Location | |||||||||
Address1: | 205 E TORONTO AVE | ||||||||
Address2: |   | ||||||||
City: | MCALLEN | ||||||||
State: | TX | ||||||||
PostalCode: | 785031209 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9566876155 | ||||||||
FaxNumber: | 9566318063 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/04/2006 | ||||||||
LastUpdateDate: | 01/24/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | K8164 | TX | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 208600000X | K8164 | TX | N |   | Allopathic & Osteopathic Physicians | Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 0965824-06 | 05 | TX |   | MEDICAID | 096582402 | 05 | TX |   | MEDICAID | 0088EN | 01 | TX | BC BS | OTHER | 00BF19 | 01 | TX | FMC BCBS GROUP | OTHER |