Healthcare Provider Details

I. General information

NPI: 1750346904
Provider Name (Legal Business Name): PHILLIP G ZINSER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 01/28/2024
Certification Date: 01/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12774 BOENKER LN
BRIDGETON MO
63044-2436
US

IV. Provider business mailing address

12774 BOENKER LN
BRIDGETON MO
63044-2436
US

V. Phone/Fax

Practice location:
  • Phone: 314-291-7997
  • Fax: 314-739-1471
Mailing address:
  • Phone: 314-291-7997
  • Fax: 314-739-1471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number2001013833
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: