Healthcare Provider Details

I. General information

NPI: 1154386829
Provider Name (Legal Business Name): JERETT AARON ZIPIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 AUTUMN SLATE DR STE 150
PFLUGERVILLE TX
78660
US

IV. Provider business mailing address

6210 E HIGHWAY 290
AUSTIN TX
78723-1142
US

V. Phone/Fax

Practice location:
  • Phone: 737-220-7200
  • Fax: 512-406-7339
Mailing address:
  • Phone: 512-483-9569
  • Fax: 512-406-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberS1025
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: