Provider Demographics
NPI:1639114176
Name:GANZ, SAMUEL B (DO)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:B
Last Name:GANZ
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 1:13509 CAMINO DE PLATA CT
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-6966
Mailing Address - Country:US
Mailing Address - Phone:361-949-8806
Mailing Address - Fax:361-949-1346
Practice Address - Street 1:13509 CAMINO DE PLATA CT
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-6966
Practice Address - Country:US
Practice Address - Phone:361-949-8806
Practice Address - Fax:361-949-1346
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC3667207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD48271Medicare UPIN
TX2559Medicare ID - Type Unspecified