Healthcare Provider Details

I. General information

NPI: 1063494839
Provider Name (Legal Business Name): JEFFREY ZSOHAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 WORTH ST BAYLOR COMMUNITY CARE AT WORTH ST
DALLAS TX
75246-1608
US

IV. Provider business mailing address

4001 WORTH ST BAYLOR COMMUNITY CARE AT WORTH ST
DALLAS TX
75246-1608
US

V. Phone/Fax

Practice location:
  • Phone: 214-828-1745
  • Fax: 214-828-1734
Mailing address:
  • Phone: 214-828-1745
  • Fax: 214-828-1734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number40283
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP4275
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: