Healthcare Provider Details

I. General information

NPI: 1497761753
Provider Name (Legal Business Name): MARC E ZOOK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 HESTERS CROSSING
ROUND ROCK TX
78681-8018
US

IV. Provider business mailing address

PO BOX 26726
AUSTIN TX
78755-0726
US

V. Phone/Fax

Practice location:
  • Phone: 512-244-9024
  • Fax: 512-218-3704
Mailing address:
  • Phone: 512-407-8686
  • Fax: 512-406-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL8569
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: