Provider Demographics
NPI:1932294659
Name:GANC, JAIME (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:
Last Name:GANC
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 1:6776 SOUTHWEST FWY
Mailing Address - Street 2:STE 630
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2107
Mailing Address - Country:US
Mailing Address - Phone:713-524-0058
Mailing Address - Fax:713-524-8584
Practice Address - Street 1:6776 SOUTHWEST FWY
Practice Address - Street 2:STE 630
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2107
Practice Address - Country:US
Practice Address - Phone:713-524-0058
Practice Address - Fax:713-524-8584
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0925174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1238149-03Medicaid
TX1238149-03Medicaid
TX00R254Medicare ID - Type Unspecified