Provider Demographics
NPI:1962841700
Name:GANZ, JOHN ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:GANZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:636 LONG POINT RD UNIT G132
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8286
Mailing Address - Country:US
Mailing Address - Phone:843-284-6165
Mailing Address - Fax:843-790-1820
Practice Address - Street 1:1671 BELLE ISLE AVE STE 110
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8336
Practice Address - Country:US
Practice Address - Phone:843-284-6165
Practice Address - Fax:843-790-1820
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC358662084P0800X, 2084P0804X
SCMD358662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty