Healthcare Provider Details

I. General information

NPI: 1740237973
Provider Name (Legal Business Name): STEWART LEE ZUCKERBROD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 WEST LOOP S STE 100
BELLAIRE TX
77401-2904
US

IV. Provider business mailing address

6330 WEST LOOP S STE 100
BELLAIRE TX
77401-2904
US

V. Phone/Fax

Practice location:
  • Phone: 713-661-6500
  • Fax: 713-661-6327
Mailing address:
  • Phone: 713-661-6500
  • Fax: 713-661-6327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG7433
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: