1427079300 NPI number — DR. ERICA J ZWERNEMANN M.D.

Table of content: DR. ERICA J ZWERNEMANN M.D. (NPI 1427079300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427079300 NPI number — DR. ERICA J ZWERNEMANN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZWERNEMANN
Provider First Name:
ERICA
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427079300
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
731 E SOUTHLAKE BLVD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
SOUTHLAKE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76092-6377
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-912-8800
Provider Business Mailing Address Fax Number:
817-912-8810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
731 E SOUTHLAKE BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SOUTHLAKE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76092-6377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-912-8800
Provider Business Practice Location Address Fax Number:
817-912-8810
Provider Enumeration Date:
07/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  L0731 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 85496X . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 045546101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 045546102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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