Healthcare Provider Details

I. General information

NPI: 1083949648
Provider Name (Legal Business Name): THOMAS ZINK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 LAFAYETTE AVE SUITE 400
SAINT LOUIS MO
63104-1314
US

IV. Provider business mailing address

3545 LAFAYETTE AVE SUITE 400
SAINT LOUIS MO
63104-1314
US

V. Phone/Fax

Practice location:
  • Phone: 215-681-3433
  • Fax:
Mailing address:
  • Phone: 215-681-3433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR2C88MD
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberR2C88MD
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberR2C88MD
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: