Provider Demographics
NPI:1629027610
Name:ZISSIMOS, ANTHONY GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:GEORGE
Last Name:ZISSIMOS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2800 S TEXAS AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5361
Mailing Address - Country:US
Mailing Address - Phone:979-774-2053
Mailing Address - Fax:979-776-5914
Practice Address - Street 1:3201 UNIVERSITY DR E STE 115
Practice Address - Street 2:SUITE 115
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3476
Practice Address - Country:US
Practice Address - Phone:530-414-1104
Practice Address - Fax:979-776-1372
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP0812207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG29705Medicare UPIN