Provider Demographics
NPI:1275784886
Name:ZIGROSSI, DOMINIC A (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:A
Last Name:ZIGROSSI
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 1:20 W LUCERNE CIR
Mailing Address - Street 2:APT 202
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3728
Mailing Address - Country:US
Mailing Address - Phone:814-360-4238
Mailing Address - Fax:
Practice Address - Street 1:86 W UNDERWOOD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1110
Practice Address - Country:US
Practice Address - Phone:407-237-6329
Practice Address - Fax:407-649-3083
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN11053390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program