Healthcare Provider Details

I. General information

NPI: 1942482575
Provider Name (Legal Business Name): MARK ZACHARY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18275 N 59TH AVE BLDG M #176
GLENDALE AZ
85308-1260
US

IV. Provider business mailing address

18275 N 59TH AVE BLDG M #176
GLENDALE AZ
85308-1260
US

V. Phone/Fax

Practice location:
  • Phone: 602-843-2866
  • Fax: 602-938-1491
Mailing address:
  • Phone: 602-843-2866
  • Fax: 602-938-1491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number12879
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: