MEDICARE: ANTHONY I ZAGHAB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver	94-364-3413	CO

General Provider Information

NPI Number	:	1538725874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY I ZAGHAB

Provider Business Mailing Address
First Line	:	PO BOX 101181
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80250-1181
Country	:	US
Telephone Number	:	303-359-8889
Fax Number	:

Provider Business Practice Location Address
First Line	:	1244 S WADSWORTH BLVD
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80232-5437
Country	:	US
Telephone Number	:	303-669-6666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2019
Last Update Date	:	05/13/2019

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