Provider Demographics
NPI:1235134016
Name:GARCIA, EDMUNDO OSCAR (MD)
Entity type:Individual
Prefix:MR
First Name:EDMUNDO
Middle Name:OSCAR
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9673 MARBACH RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-1821
Mailing Address - Country:US
Mailing Address - Phone:210-675-8390
Mailing Address - Fax:210-675-2026
Practice Address - Street 1:9673 MARBACH RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-1821
Practice Address - Country:US
Practice Address - Phone:210-675-8390
Practice Address - Fax:210-675-2026
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1401207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0334054Medicaid
TX00FZ65Medicare ID - Type Unspecified
TX0334054Medicaid