Provider Demographics
NPI:1720010945
Name:GWOZDZ, JOHN THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS
Last Name:GWOZDZ
Suffix:
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:1000 S COULTER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1781
Practice Address - Country:US
Practice Address - Phone:806-358-8654
Practice Address - Fax:806-356-7772
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK22132085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116853604Medicaid
TX116853606Medicaid
TX048598902Medicaid
TX8R1453OtherBLUE CROSS OF TEXAS
TX116853606Medicaid
TXG44982Medicare UPIN
TXP00086527Medicare PIN
TX116853604Medicaid