Healthcare Provider Details

I. General information

NPI: 1609800176
Provider Name (Legal Business Name): SCOTT JEREMY ZUICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11133 DUNN RD SUITE 2335
SAINT LOUIS MO
63136-6119
US

IV. Provider business mailing address

11133 DUNN RD SUITE 2335
SAINT LOUIS MO
63136-6119
US

V. Phone/Fax

Practice location:
  • Phone: 314-653-5007
  • Fax: 314-653-4149
Mailing address:
  • Phone: 314-653-5007
  • Fax: 314-653-4149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMT194441
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: