Healthcare Provider Details

I. General information

NPI: 1932165503
Provider Name (Legal Business Name): MAURO S GANZON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 N FM 730 #105
BOYD TX
76023-3084
US

IV. Provider business mailing address

1512 TEASLEY LN
DENTON TX
76205-7282
US

V. Phone/Fax

Practice location:
  • Phone: 940-433-2151
  • Fax: 940-433-2366
Mailing address:
  • Phone: 940-442-5209
  • Fax: 940-222-2720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL4946
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: