Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 54285 | CO |
N | 207XS0117X | Orthopaedic Spine Surgeon | 5315058385 | MI |
N | 207XS0117X | Orthopaedic Spine Surgeon | 54285 | CO |
Y | 207XS0117X | Orthopaedic Spine Surgeon | R4350 | TX |
NPI | 1013285758 |
---|---|
Provider Name | Anton Vladimir Zaryanov |
First Address | Rockwall, TX 75032-7815 |
Second Address | Rockwall, TX 75032-7815 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2011 |
Last Update Date | 28/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
370936YL31 | MEDICARE PTAN (01) | CO |
85035769 | (05) | CO |