Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | D0017174 | MD |
N | 207VG0400X | Gynecologist | ME91824 | FL |
NPI | 1124024500 |
---|---|
Provider Name | Dr. David Leslie Zisow |
First Address | Forest Hill, MD 21050-2621 |
Second Address | Forest Hill, MD 21050-2621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 18/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
972911900 | (05) | MD |
C57411 | (02) | MD |