MEDICARE: MAURO S GANZON 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	207Q00000X	Family Medicine Physician	L4946	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8CU824	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1932165503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAURO S GANZON MD

Provider Business Mailing Address
First Line	:	1512 TEASLEY LN
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76205-7282
Country	:	US
Telephone Number	:	940-442-5209
Fax Number	:	940-222-2720

Provider Business Practice Location Address
First Line	:	133 N FM 730
Second Line	:	#105
City	:	BOYD
State	:	TX
Zip	:	76023-3084
Country	:	US
Telephone Number	:	940-433-2151
Fax Number	:	940-433-2366

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

Provider Enumeration Date	:	04/24/2006
Last Update Date	:	12/15/2025

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Directions to “ MAURO S GANZON MD” Practice Location

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