Healthcare Provider Details

I. General information

NPI: 1619922663
Provider Name (Legal Business Name): NEIL ZUCKER D.O,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12222 MERIT DR STE 600
DALLAS TX
75251-3294
US

IV. Provider business mailing address

PO BOX 840853
DALLAS TX
75284-0865
US

V. Phone/Fax

Practice location:
  • Phone: 972-715-5000
  • Fax: 972-715-9976
Mailing address:
  • Phone: 972-233-1999
  • Fax: 972-233-3666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberL8570
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberL8570
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: