Healthcare Provider Details

I. General information

NPI: 1891894606
Provider Name (Legal Business Name): JAMES VICTOR ZIRUL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 09/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 SPUR VIEW DRIVE
KENAI AK
99611-6880
US

IV. Provider business mailing address

220 SPUR VIEW DRIVE
KENAI AK
99611-6880
US

V. Phone/Fax

Practice location:
  • Phone: 907-283-5400
  • Fax: 907-283-6443
Mailing address:
  • Phone: 907-283-5400
  • Fax: 907-283-6443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberAA2384
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number5101008707
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: