Healthcare Provider Details

I. General information

NPI: 1104821016
Provider Name (Legal Business Name): ROBERT C VANZANT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BOB C VANZANT MD

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date: 03/18/2006
Reactivation Date: 03/25/2006

III. Provider practice location address

21820 KATY FWY STE 200
KATY TX
77449-7901
US

IV. Provider business mailing address

PO BOX 392929
PITTSBURGH PA
15251-9900
US

V. Phone/Fax

Practice location:
  • Phone: 713-461-2915
  • Fax: 713-461-5307
Mailing address:
  • Phone: 713-461-2915
  • Fax: 713-431-5307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE2911
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: