Provider Demographics
NPI:1013285758
Name:ZARYANOV, ANTON VLADIMIR (DO)
Entity Type:Individual
Prefix:
First Name:ANTON
Middle Name:VLADIMIR
Last Name:ZARYANOV
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3142 HORIZON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-7815
Mailing Address - Country:US
Mailing Address - Phone:972-772-9600
Mailing Address - Fax:972-772-9601
Practice Address - Street 1:3142 HORIZON RD STE 100
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-7815
Practice Address - Country:US
Practice Address - Phone:972-772-9600
Practice Address - Fax:972-772-9601
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO54285207X00000X, 207XS0117X
MI5315058385207XS0117X
TXR4350207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO370936YL31OtherMEDICARE PTAN
CO85035769Medicaid