Healthcare Provider Details

I. General information

NPI: 1104645332
Provider Name (Legal Business Name): BRANDON ZUERCHER RD, LD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 LONDONDERRY DR STE 310
WACO TX
76712-7922
US

IV. Provider business mailing address

7112 BELFAST CIR
WACO TX
76712-3963
US

V. Phone/Fax

Practice location:
  • Phone: 254-751-4097
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT86130
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: