Healthcare Provider Details

I. General information

NPI: 1467407510
Provider Name (Legal Business Name): DEBORAH JANE ZYGMUNT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 N LAURENT ST STE 150
VICTORIA TX
77901-5417
US

IV. Provider business mailing address

337 CHAMPLAIN ST
VICTORIA TX
77905-3697
US

V. Phone/Fax

Practice location:
  • Phone: 361-793-5219
  • Fax:
Mailing address:
  • Phone: 361-579-7255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01032862A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: