Provider Demographics
NPI:1851460448
Name:ZORN, GEORGE G III (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:G
Last Name:ZORN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4060 FOURTH AVENUE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2190
Mailing Address - Country:US
Mailing Address - Phone:619-298-9931
Mailing Address - Fax:619-298-3613
Practice Address - Street 1:4060 FOURTH AVENUE
Practice Address - Street 2:SUITE 330
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2190
Practice Address - Country:US
Practice Address - Phone:619-298-9931
Practice Address - Fax:619-298-3613
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31404208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9815415Medicaid
A44761Medicare UPIN
W4910Medicare ID - Type Unspecified