Provider Demographics
NPI:1891844866
Name:FERRUZZI, GIANCARLO ROBERTO (MD)
Entity Type:Individual
Prefix:
First Name:GIANCARLO
Middle Name:ROBERTO
Last Name:FERRUZZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GIANCARLO
Other - Middle Name:ROBERTO
Other - Last Name:FERRUZZI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6502 NURSERY DR.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904
Mailing Address - Country:US
Mailing Address - Phone:210-614-9800
Mailing Address - Fax:210-593-0967
Practice Address - Street 1:13409 NW MILITARY HWY
Practice Address - Street 2:SUITE 310
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78231
Practice Address - Country:US
Practice Address - Phone:210-614-9800
Practice Address - Fax:210-593-0967
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH99242084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096834903Medicaid
TX0067BPOtherBCBS
TX096834902Medicaid
TX8U9624OtherBCBS
TX096834902Medicaid
TX8U9624OtherBCBS
8K0451Medicare PIN