Individual
JOHN G. GANCAYCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3551 ROGER BROOKE DR, JBSA FT SAM HOUSTON, TX 78234
(210) 916-2338
Mailing address
3551 ROGER BROOKE DR, SAN ANTONIO, TX 78234-4504
(210) 916-4367
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101241245
VA
207RG0100X
Gastroenterology Physician
0101241245
VA
207RG0100X
Gastroenterology Physician
Primary
R1954
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
375517502
—
TX
01
—
375517503
CSHCN
TX
Enumeration date
05/08/2007
Last updated
01/17/2020
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