Healthcare Provider Details

I. General information

NPI: 1639376320
Provider Name (Legal Business Name): MOZOW ZUIDEMA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 E BROADWAY STE 300
COLUMBIA MO
65201-8023
US

IV. Provider business mailing address

1605 E BROADWAY STE 300
COLUMBIA MO
65201-8023
US

V. Phone/Fax

Practice location:
  • Phone: 573-256-7700
  • Fax: 573-256-3003
Mailing address:
  • Phone: 573-256-7700
  • Fax: 573-256-3003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2014007090
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2007018559
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36763
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number36763
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: