MEDICARE: GABRIEL T FAZ MD

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	207R00000X	Internal Medicine Physician	MD228498	OR
2	207RI0011X	Interventional Cardiology Physician	036173571	IL
3	207RC0000X	Cardiovascular Disease Physician	14193490-1235	UT
4	207RI0011X	Interventional Cardiology Physician	R3509	TX
5	390200000X	Student in an Organized Health Care Education/Training Program	BP1-0037459	TX
6	207R00000X	Internal Medicine Physician	MD61254187	WA

General Provider Information

NPI Number	:	1285936625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL T FAZ MD

Provider Business Mailing Address
First Line	:	200 W MAGNOLIA AVE STE 201
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76104-7657
Country	:	US
Telephone Number	:	817-702-2977
Fax Number	:	817-702-2140

Provider Business Practice Location Address
First Line	:	1500 S MAIN ST
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76104-4917
Country	:	US
Telephone Number	:	817-702-1100
Fax Number	:	817-702-1101

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

Provider Enumeration Date	:	11/17/2010
Last Update Date	:	01/21/2026

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