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NPI Code Detail

MEDICARE: STEVEN EDWARD ZACK MD

MEDICARE: STEVEN EDWARD ZACK MD
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
1207L00000XAnesthesiology PhysicianMD10279OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558398578
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEVEN EDWARD ZACK MD
Provider Business Mailing Address
First Line : PO BOX 4008
Second Line :
City : PORTLAND
State : OR
Zip : 97208-4008
Country : US
Telephone Number : 503-372-2740
Fax Number : 503-372-2754
Provider Business Practice Location Address
First Line : 19300 SW 65TH AVE
Second Line :
City : TUALATIN
State : OR
Zip : 97062-7706
Country : US
Telephone Number : 503-692-1212
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2006
Last Update Date : 07/08/2007

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