Healthcare Provider Details

I. General information

NPI: 1962443812
Provider Name (Legal Business Name): GARY J MASZAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 01/24/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 W IH 10 SUITE 200
SAN ANTONIO TX
78201-2038
US

IV. Provider business mailing address

6800 W IH 10 SUITE 200
SAN ANTONIO TX
78201-2038
US

V. Phone/Fax

Practice location:
  • Phone: 210-271-3203
  • Fax: 210-733-6983
Mailing address:
  • Phone: 210-271-3203
  • Fax: 210-733-6983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberM3313
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberM3313
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: