MEDICARE: DR. GARY P. FAZIO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0011X	Interventional Cardiology Physician	K0742	TX
2	207RC0000X	Cardiovascular Disease Physician	K0742	TX

General Provider Information

NPI Number	:	1255331955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY P. FAZIO M.D.

Provider Business Mailing Address
First Line	:	3315 UNICORN LAKE BLVD STE 171
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76210-0127
Country	:	US
Telephone Number	:	940-320-2188
Fax Number	:

Provider Business Practice Location Address
First Line	:	3315 UNICORN LAKE BLVD STE 171
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76210-0127
Country	:	US
Telephone Number	:	940-320-2188
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	05/26/2022

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