Healthcare Provider Details

I. General information

NPI: 1811910151
Provider Name (Legal Business Name): BRIAN JOSEPH ZAGAR D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 12/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 MCQUEEN SMITH RD N
PRATTVILLE AL
36066-5558
US

IV. Provider business mailing address

546 MCQUEEN SMITH RD N
PRATTVILLE AL
36066-5558
US

V. Phone/Fax

Practice location:
  • Phone: 334-358-9765
  • Fax: 334-358-5434
Mailing address:
  • Phone: 334-358-9765
  • Fax: 334-358-5434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number229
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: