Healthcare Provider Details

I. General information

NPI: 1376579862
Provider Name (Legal Business Name): VICENTE F MAZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S MCGEE ST
BORGER TX
79007-4022
US

IV. Provider business mailing address

PO BOX 8337
AMARILLO TX
79114-8337
US

V. Phone/Fax

Practice location:
  • Phone: 806-355-6593
  • Fax:
Mailing address:
  • Phone: 806-355-6593
  • Fax: 806-352-8774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberE7186
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberE7186
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberE7186
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberE7186
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: