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NPI Code Detail

MEDICARE: SIDNEY BENJAMIN ZEICHNER MD

MEDICARE: SIDNEY BENJAMIN ZEICHNER 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
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine PhysicianS8677TX

General Provider Information

NPI Number : 1700347499
Entity Type Code : Individual
Provider Name (Legal Business Name) : SIDNEY BENJAMIN ZEICHNER MD
Provider Business Mailing Address
First Line : 3100 FAIRFIELD AVE # 1D
Second Line :
City : SHREVEPORT
State : LA
Zip : 71104-4152
Country : US
Telephone Number : 512-574-5553
Fax Number :
Provider Business Practice Location Address
First Line : 1500 S MAIN ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4941
Country : US
Telephone Number : 817-702-1244
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2019
Last Update Date : 01/18/2021

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