Provider Demographics
NPI:1104853795
Name:ZIGLER, JACK E (MD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:E
Last Name:ZIGLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 262409
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75026-2409
Mailing Address - Country:US
Mailing Address - Phone:972-608-5000
Mailing Address - Fax:972-608-5020
Practice Address - Street 1:6020 W PARKER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8171
Practice Address - Country:US
Practice Address - Phone:972-608-5000
Practice Address - Fax:972-608-5020
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK17410207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1299315-02Medicaid
TX1299315-02Medicaid
TX86X485Medicare PIN