Basic Information
Provider Information
NPI: 1629539069
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GARZON
FirstName: MEGAN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1918 RIDGECREST DR
Address2:  
City: HOUSTON
State: TX
PostalCode: 770551406
CountryCode: US
TelephoneNumber: 3463243955
FaxNumber:  
Practice Location
Address1: 11503 NW MILITARY HWY STE 202
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782311895
CountryCode: US
TelephoneNumber: 2102336363
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/28/2019
LastUpdateDate: 07/19/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/19/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XT4924TXY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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