Provider Demographics
NPI:1285746040
Name:GANZ, RICHARD R (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:R
Last Name:GANZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:455 MARCH AVE SUIE C
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3378
Mailing Address - Country:US
Mailing Address - Phone:707-433-8817
Mailing Address - Fax:707-433-7907
Practice Address - Street 1:455 MARCH AVE SUITE C
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3378
Practice Address - Country:US
Practice Address - Phone:707-433-8817
Practice Address - Fax:707-433-7907
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-06-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG30698207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG30698Medicare PIN
CA00G36980Medicare ID - Type Unspecified
CAA44517Medicare UPIN