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NPI Code Detail

MEDICARE: DR. GARTH O VAZ M.D.

MEDICARE: DR. GARTH O VAZ 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
1207Q00000XFamily Medicine PhysicianJ3644TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1J3644OTHERTXSTATE LI
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285636647
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARTH O VAZ M.D.
Provider Business Mailing Address
First Line : 1103 N SARAH DEWITT DR
Second Line : P.O. BOX 562
City : GONZALES
State : TX
Zip : 78629-3311
Country : US
Telephone Number : 830-672-2424
Fax Number : 866-622-2180
Provider Business Practice Location Address
First Line : 1103 N SARAH DEWITT DR
Second Line : 1103 N. SAHAH DEWITT DRIVE
City : GONZALES
State : TX
Zip : 78629-3311
Country : US
Telephone Number : 830-672-2424
Fax Number : 866-622-2180
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2005
Last Update Date : 07/19/2016

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