Provider Demographics
NPI:1972577534
Name:WASSMUTH, ZACHARY D (MD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:D
Last Name:WASSMUTH
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 1:12309 N MOPAC EXPRESSWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2577
Mailing Address - Country:US
Mailing Address - Phone:512-339-4040
Mailing Address - Fax:512-997-9077
Practice Address - Street 1:12309 N MOPAC EXPY STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2604
Practice Address - Country:US
Practice Address - Phone:512-339-4040
Practice Address - Fax:512-339-1663
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5608174400000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3389220OtherAETNA
H80037Medicare UPIN
3389220OtherAETNA