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General NPI Number Information
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NPI Number | 1992879068
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Entity Type | Organization
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Legal Business Name | DIAGNOSTIC & INTERNAL MEDICINE CLINIC PA
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2929 CALDER STREET SUITE 308
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City | BEAUMONT
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State | TX
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Zip | 77702
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Country | US
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Telephone | 409-833-2929
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Fax | 409-839-8355
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Provider Business Mailing Address
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Address Line | 2929 CALDER STREET SUITE 308
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City | BEAUMONT
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State | TX
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Zip | 77702
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Country | US
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Telephone | 409-833-2929
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Fax | 409-839-8355
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | GEORGE V ZUZUKIN
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Credential | MD
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Telephone | 409-833-2929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 69255
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License Number State | TX
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