Provider Demographics
NPI:1548557556
Name:DEAN L ZINCONE MD PA
Entity Type:Organization
Organization Name:DEAN L ZINCONE MD PA
Other - Org Name:DEAN L ZINCONE MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEICKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-401-4401
Mailing Address - Street 1:1355 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5130
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1355 E COURT ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5130
Practice Address - Country:US
Practice Address - Phone:830-401-4401
Practice Address - Fax:830-303-5225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5959207Q00000X
TXPA05308363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120510603Medicaid
TX120510604Medicaid
TX120510603Medicaid
TXF75889Medicare UPIN
TXN01BMedicare PIN