Provider Demographics
NPI:1982698395
Name:GARZA, RENE (DO)
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:
Last Name:GARZA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22519 LYNRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7747
Mailing Address - Country:US
Mailing Address - Phone:210-497-2224
Mailing Address - Fax:
Practice Address - Street 1:1250 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-2551
Practice Address - Country:US
Practice Address - Phone:419-238-8659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.007750207P00000X
TXM2327207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176359107Medicaid
TX8X7672OtherBCBS
TX8F5087OtherBCBS
TX8U9779OtherBCBS
TX176359101Medicaid
TX176359103Medicaid
TX176359105Medicaid
TX8W1163OtherBCBS
TX8EG480OtherBCBSTX
TX8EX761OtherBCBSTX
OH2348383Medicaid
TX8G5870Medicare PIN
TX8EX761OtherBCBSTX
OHGA7307991Medicare PIN
TXP00333278Medicare PIN
H67183Medicare UPIN
TX176359105Medicaid
TXP00344657Medicare PIN
TX8X7672OtherBCBS
TX8F5138Medicare PIN
TX8D9793Medicare PIN