Healthcare Provider Details

I. General information

NPI: 1356908776
Provider Name (Legal Business Name): GREGORY ZIOMEK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 MILLS AVE FL 6
AUSTIN TX
78731-6309
US

IV. Provider business mailing address

3501 MILLS AVE
AUSTIN TX
78731-6309
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-2000
  • Fax:
Mailing address:
  • Phone: 512-324-2036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberU0462
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: