Provider Demographics
NPI:1114970910
Name:SCHUCANY, WILLIAM GREGORY (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GREGORY
Last Name:SCHUCANY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 W TIDWELL RD
Mailing Address - Street 2:STE 103
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-5719
Mailing Address - Country:US
Mailing Address - Phone:832-413-5302
Mailing Address - Fax:832-413-5302
Practice Address - Street 1:3500 GASTON AVENUE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246
Practice Address - Country:US
Practice Address - Phone:214-826-8822
Practice Address - Fax:214-826-9792
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK17632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132306510Medicaid
TX132306511Medicaid
TX132306512Medicaid
TX8A6957Medicare PIN
TX132306512Medicaid
G45004Medicare UPIN
TXP00133079Medicare PIN
TXP00034797Medicare PIN
TX132306510Medicaid
TX8084B9Medicare PIN
TX8C8514Medicare PIN