Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | Q6190 | TX |
NPI | 1023453743 |
---|---|
Provider Name | Ricardo Garcia JR. |
First Address | Bryan, TX 77802-3499 |
Second Address | Bryan, TX 77802-3499 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2013 |
Last Update Date | 27/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
353923102 | (05) | TX |