Provider Demographics
NPI:1710367446
Name:ZAJAC, MARISSA MAY (DO)
Entity Type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:MAY
Last Name:ZAJAC
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:5521 BELLAIRE DR S STE 114B
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-5855
Mailing Address - Country:US
Mailing Address - Phone:817-926-9642
Mailing Address - Fax:817-926-1865
Practice Address - Street 1:5521 BELLAIRE DR S STE 114B
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-5855
Practice Address - Country:US
Practice Address - Phone:817-926-9642
Practice Address - Fax:817-926-1865
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WVED204D00000X
TXR9898204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM