Individual
ISMIN ZEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1600 BROAD AVE, GULFPORT, MS 39501-3603
(228) 863-1132
(228) 865-1700
Mailing address
1600 BROAD AVE, GULFPORT, MS 39501-3603
(228) 863-1132
(228) 865-1700
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
15346
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00018213
—
MS
01
—
255650247B
BLUE CROSS BLUE SHIELD
MS
01
—
640478777
TRICARE CHAMPUS
MS
Enumeration date
07/06/2006
Last updated
06/08/2015
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