Provider Demographics
NPI:1740237973
Name:ZUCKERBROD, STEWART LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEWART
Middle Name:LEE
Last Name:ZUCKERBROD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 WEST LOOP S STE 100
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2904
Mailing Address - Country:US
Mailing Address - Phone:713-661-6500
Mailing Address - Fax:713-661-6327
Practice Address - Street 1:6330 WEST LOOP S STE 100
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2904
Practice Address - Country:US
Practice Address - Phone:713-661-6500
Practice Address - Fax:713-661-6327
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7433207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139273017Medicaid
TX139273016Medicaid
TX8K1041Medicare PIN
TX00269RMedicare PIN
TX8F24405Medicare PIN