Healthcare Provider Details

I. General information

NPI: 1033311303
Provider Name (Legal Business Name): ZOMPA GUDERIAN ENTERPRISES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 12/19/2016
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: 409-744-8844
Mailing address:
  • Phone: 409-744-9800
  • Fax: 409-744-8844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberJ8561
License Number StateTX

VIII. Authorized Official

Name: EDWARD ZOMPA
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 409-744-9800