1083764419 NPI number — GERALD N. ZERINGUE DPM

Table of content: GERALD N. ZERINGUE DPM (NPI 1083764419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083764419 NPI number — GERALD N. ZERINGUE DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZERINGUE
Provider First Name:
GERALD
Provider Middle Name:
N.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

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:
1083764419
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5656 BEE CAVES RD
Provider Second Line Business Mailing Address:
STE D204
Provider Business Mailing Address City Name:
WEST LAKE HILLS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78746-5236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-447-2025
Provider Business Mailing Address Fax Number:
512-447-4968

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4207 JAMES CASEY ST
Provider Second Line Business Practice Location Address:
STE. 315
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78745-3300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-447-2025
Provider Business Practice Location Address Fax Number:
512-447-4968
Provider Enumeration Date:
01/10/2007

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: 213E00000X , with the licence number:  0823 , 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: 00DG46 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 127196704 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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