MEDICARE: JOHN ZACHARY PA

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	363A00000X	Physician Assistant	117073-1206	UT

General Provider Information

NPI Number	:	1871580829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN ZACHARY PA

Provider Business Mailing Address
First Line	:	1055 N 300 W
Second Line	:	STE. 500
City	:	PROVO
State	:	UT
Zip	:	84604-3344
Country	:	US
Telephone Number	:	801-357-7291
Fax Number	:	801-357-7919

Provider Business Practice Location Address
First Line	:	1055 N 300 W
Second Line	:	STE. 500
City	:	PROVO
State	:	UT
Zip	:	84604-3344
Country	:	US
Telephone Number	:	801-357-7291
Fax Number	:	801-357-7919

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	04/26/2016

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Directions to “ JOHN ZACHARY PA” Practice Location

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