Provider Demographics
NPI:1265421499
Name:ZERUCHA, GEORGE FRANCIS (PA-C)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:FRANCIS
Last Name:ZERUCHA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 OAK ISLE DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-7523
Mailing Address - Country:US
Mailing Address - Phone:903-452-0039
Mailing Address - Fax:903-663-9468
Practice Address - Street 1:121 OAK ISLE DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-7523
Practice Address - Country:US
Practice Address - Phone:903-452-0039
Practice Address - Fax:903-663-9468
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA-01038363A00000X
NY004133363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR55771Medicare UPIN