Healthcare Provider Details

I. General information

NPI: 1558343871
Provider Name (Legal Business Name): GREGG STEVEN ZANKMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S POWER RD STE 106
MESA AZ
85206-5236
US

IV. Provider business mailing address

215 S POWER RD STE 106
MESA AZ
85206-5236
US

V. Phone/Fax

Practice location:
  • Phone: 480-214-0051
  • Fax: 480-214-0055
Mailing address:
  • Phone: 480-214-0051
  • Fax: 480-214-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A15798
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3618
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: