Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | S1025 | TX |
NPI | 1154386829 |
---|---|
Provider Name | Dr. Jerett Aaron Zipin |
First Address | Austin, TX 78723-1142 |
Second Address | Pflugerville, TX 78660 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2006 |
Last Update Date | 06/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
400567001 | (05) | TX |
400567002 | (05) | TX |