Healthcare Provider Details

I. General information

NPI: 1487705810
Provider Name (Legal Business Name): ISMENE NIKOLAOS ZOIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2007
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GWEE SHUT RD
SILETZ OR
97380-2036
US

IV. Provider business mailing address

PO BOX 320
SILETZ OR
97380-0320
US

V. Phone/Fax

Practice location:
  • Phone: 541-444-1030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberJ8178
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD227842
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: