MEDICARE: BENNETT SCOTT ZIVNEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	H6730	TX

General Provider Information

NPI Number	:	1366449092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENNETT SCOTT ZIVNEY MD

Provider Business Mailing Address
First Line	:	1602 ROCK PRAIRIE RD
Second Line	:	SUITE 430
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-8306
Country	:	US
Telephone Number	:	979-693-0737
Fax Number	:	979-693-7442

Provider Business Practice Location Address
First Line	:	1602 ROCK PRAIRIE RD
Second Line	:	SUITE 430
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-8306
Country	:	US
Telephone Number	:	979-693-0737
Fax Number	:	979-693-7442

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/08/2007

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