Provider Demographics
NPI:1790188514
Name:ZISLIS, GEORGE
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:ZISLIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9422 ARLINGTON EXPY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-8231
Mailing Address - Country:US
Mailing Address - Phone:904-559-1844
Mailing Address - Fax:904-900-7707
Practice Address - Street 1:9422 ARLINGTON EXPY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-8231
Practice Address - Country:US
Practice Address - Phone:904-559-1844
Practice Address - Fax:904-900-7707
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPR384213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine