Healthcare Provider Details

I. General information

NPI: 1093713497
Provider Name (Legal Business Name): JAMES M ZODROW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 AMERICAN DR SUITE 203
PLANO TX
75075-6191
US

IV. Provider business mailing address

3900 AMERICAN DR SUITE 203
PLANO TX
75075-6191
US

V. Phone/Fax

Practice location:
  • Phone: 972-398-0734
  • Fax: 972-398-0736
Mailing address:
  • Phone: 972-398-0734
  • Fax: 972-398-0736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberJ3662
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: