Provider Demographics
NPI:1255376851
Name:ZEIGLER, MARK ROY (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ROY
Last Name:ZEIGLER
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 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:
Practice Address - Street 1:1107 W POINSETT ST
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1318
Practice Address - Country:US
Practice Address - Phone:864-879-8886
Practice Address - Fax:864-879-1204
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18877207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC188772Medicaid
SCP00713072OtherRR MEDICARE
SCP00713072OtherRR MEDICARE
SCG665427951Medicare PIN
SC188772Medicaid
SC5219534OtherAETNA ID
SC4073693OtherCIGNA ID