Healthcare Provider Details

I. General information

NPI: 1265457667
Provider Name (Legal Business Name): EDWARD ZOMPA M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 01/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2027 61ST ST
GALVESTON TX
77551-1401
US

IV. Provider business mailing address

2027 61ST ST
GALVESTON TX
77551-1401
US

V. Phone/Fax

Practice location:
  • Phone: 409-744-9800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberK8705
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: