Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | C3667 | TX |
NPI | 1639114176 |
---|---|
Provider Name | Dr. Samuel B. Ganz |
First Address | Corpus Christi, TX 78418-6966 |
Second Address | Corpus Christi, TX 78418-6966 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D48271 | (02) | TX |