Provider Demographics
NPI:1982719381
Name:ZENI, PHILLIP THOMAS JR (MD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:THOMAS
Last Name:ZENI
Suffix:JR
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 1:6126 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4710
Mailing Address - Country:US
Mailing Address - Phone:901-779-5000
Mailing Address - Fax:901-248-7275
Practice Address - Street 1:6126 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4710
Practice Address - Country:US
Practice Address - Phone:901-779-5000
Practice Address - Fax:901-248-7275
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2019-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN315072085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204797500Medicaid
MSP000687866OtherMEDICARE RR
TN300103741OtherMEDICARE RR
TN3846470Medicaid
AR98364OtherBCBS
MS00121444Medicaid
AR135185001Medicaid
TN3141910OtherBCBS