Provider Demographics
NPI:1962443812
Name:MASZAK, GARY J (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:J
Last Name:MASZAK
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 1:6800 W IH 10
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-2038
Mailing Address - Country:US
Mailing Address - Phone:210-271-3203
Mailing Address - Fax:210-733-6983
Practice Address - Street 1:6800 W IH 10
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-2038
Practice Address - Country:US
Practice Address - Phone:210-271-3203
Practice Address - Fax:210-733-6983
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3313207RI0011X, 207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00948205OtherRAILROAD
TX060047582OtherRAILROAD MEDICARE
TX8CU312OtherBCBS
TX8F4522OtherBCBS
TX179869603Medicaid
TX8CU312OtherBCBS
TX8G5898Medicare ID - Type Unspecified
TX8F4522OtherBCBS
TXB126145Medicare PIN
TXP00948205OtherRAILROAD
TX179869601Medicaid
TXTXB108113Medicare PIN