Healthcare Provider Details

I. General information

NPI: 1629027610
Provider Name (Legal Business Name): ANTHONY GEORGE ZISSIMOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 UNIVERSITY DR E STE 115 SUITE 115
BRYAN TX
77802-3476
US

IV. Provider business mailing address

2800 S TEXAS AVE STE 202
BRYAN TX
77802-5361
US

V. Phone/Fax

Practice location:
  • Phone: 530-414-1104
  • Fax: 979-776-1372
Mailing address:
  • Phone: 979-774-2053
  • Fax: 979-776-5914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberP0812
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: