Healthcare Provider Details

I. General information

NPI: 1306818158
Provider Name (Legal Business Name): MARK ZACHARY MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 12/07/2007
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
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 Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number12879
License Number StateAZ

VIII. Authorized Official

Name: MARK ZACHARY
Title or Position: ORTHOPEDIC SURGEON
Credential: M.D.
Phone: 602-843-2866