Provider Demographics
NPI:1649281072
Name:GARCIA, POTENCIANO R JR (MD)
Entity type:Individual
Prefix:
First Name:POTENCIANO
Middle Name:R
Last Name:GARCIA
Suffix:JR
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 1:1112 E GRIFFIN PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2408
Mailing Address - Country:US
Mailing Address - Phone:956-450-3093
Mailing Address - Fax:
Practice Address - Street 1:1200 E SAVANNAH AVE STE 16
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1728
Practice Address - Country:US
Practice Address - Phone:956-631-3344
Practice Address - Fax:956-631-3881
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7214207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K9895Medicare PIN
TXD49617Medicare UPIN