Provider Demographics
NPI:1679593842
Name:GARCIA, PETE (MD)
Entity type:Individual
Prefix:
First Name:PETE
Middle Name:
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:PO BOX 81603
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78708-1603
Mailing Address - Country:US
Mailing Address - Phone:512-973-9222
Mailing Address - Fax:512-777-4527
Practice Address - Street 1:9103 SCOTTISH PASTURES CV
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-3576
Practice Address - Country:US
Practice Address - Phone:512-477-4882
Practice Address - Fax:512-477-4486
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6647207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120537901Medicaid
TX120537901Medicaid
TXQM17Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER