Provider Demographics
NPI:1649249335
Name:ZOPOLSKY, PAUL R (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:ZOPOLSKY
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 1:12029 EDGESTONE RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2340
Mailing Address - Country:US
Mailing Address - Phone:214-460-1565
Mailing Address - Fax:
Practice Address - Street 1:12029 EDGESTONE RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2340
Practice Address - Country:US
Practice Address - Phone:214-460-1565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8248207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118376603Medicaid
TX83Y775OtherBCBSTX
TX100007729Medicare PIN
TX83Y775Medicare PIN
TXB27844Medicare UPIN