Provider Demographics
NPI:1861550469
Name:SCHWARZ, GARY MORGAN
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:MORGAN
Last Name:SCHWARZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:M
Other - Last Name:SCHWARZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS MSD
Mailing Address - Street 1:4109 N 22ND STREET
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504
Mailing Address - Country:US
Mailing Address - Phone:956-687-7141
Mailing Address - Fax:956-687-8419
Practice Address - Street 1:4109 N 22ND STREET
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504
Practice Address - Country:US
Practice Address - Phone:956-687-7141
Practice Address - Fax:956-687-8419
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118541223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT15797OtherUPIN
TX126646201Medicaid
TX11854OtherLICENSE
TX126646212Medicaid
TX126646211Medicaid
TX126646213Medicaid
TXT15797OtherUPIN