Provider Demographics
NPI:1386614733
Name:ZABAWSKI, EDWARD J JR (DO)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:ZABAWSKI
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CRAWFORD AVE STE D
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-4562
Mailing Address - Country:US
Mailing Address - Phone:817-661-1520
Mailing Address - Fax:888-323-0020
Practice Address - Street 1:1200 CRAWFORD AVE STE D
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-4562
Practice Address - Country:US
Practice Address - Phone:817-661-1520
Practice Address - Fax:888-323-0020
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1959207N00000X, 207N00000X
NH14825207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30010512Medicaid
NH30228119Medicaid
NH001619301Medicare PIN
NH30228119Medicaid