Provider Demographics
NPI:1366447385
Name:ZINNI, PHILLIP CHARLES III (DO)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:CHARLES
Last Name:ZINNI
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1344 DISC DR STE 272
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-0684
Mailing Address - Country:US
Mailing Address - Phone:209-324-2255
Mailing Address - Fax:
Practice Address - Street 1:9333 DOUBLE R BLVD STE 100
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-2962
Practice Address - Country:US
Practice Address - Phone:775-636-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5756207QS0010X, 207QS0010X
IL036090281207QA0505X
NV906207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB217136OtherMEDICARE ID