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Organization
GANZON CLINIC PA
Active
Organization
GANZON CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAURO S GANZON MD (PRESIDENT)
(817) 523-5402
Entity
Organization
Contact information
Practice address
499 E HWY 199, SPRINGTOWN, TX 76082
(817) 523-5402
(817) 523-5422
Mailing address
PO BOX 1039, SPRINGTOWN, TX 76082
(817) 523-5402
(817) 523-5422
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
84LZ
BCBS
TX
Enumeration date
04/24/2006
Last updated
08/22/2020
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