Provider Demographics
NPI:1932215928
Name:ZANDERS, MARY JOSEPHINE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JOSEPHINE
Last Name:ZANDERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12121 RICHMOND AVE STE 221
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2422
Mailing Address - Country:US
Mailing Address - Phone:281-496-9378
Mailing Address - Fax:713-943-5916
Practice Address - Street 1:12121 RICHMOND AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2432
Practice Address - Country:US
Practice Address - Phone:281-496-9480
Practice Address - Fax:713-943-5916
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7529207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX76-0317435OtherEIN
TXE64932Medicare UPIN
TX76-0317435OtherEIN