Provider Demographics
NPI:1609824655
Name:ZUCKER, GARIMA PRASAD (DO)
Entity Type:Individual
Prefix:DR
First Name:GARIMA
Middle Name:PRASAD
Last Name:ZUCKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1859 BROKEN BEND DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-8205
Mailing Address - Country:US
Mailing Address - Phone:817-907-2458
Mailing Address - Fax:
Practice Address - Street 1:720 E HURST BLVD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053
Practice Address - Country:US
Practice Address - Phone:817-907-2458
Practice Address - Fax:817-481-6828
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3440207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH71549Medicare UPIN