Provider Demographics
NPI:1962462994
Name:ZEECK, PHILLIP R (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:R
Last Name:ZEECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 593
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4441
Mailing Address - Country:US
Mailing Address - Phone:432-337-6617
Mailing Address - Fax:432-337-4905
Practice Address - Street 1:500 N WASHINGTON AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4401
Practice Address - Country:US
Practice Address - Phone:432-337-6617
Practice Address - Fax:432-337-4905
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD1123174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00466661OtherRAILROAD MEDICARE
TXP00466661OtherRAILROAD MEDICARE
TX00T013Medicare PIN