Healthcare Provider Details

I. General information

NPI: 1326029026
Provider Name (Legal Business Name): KEITH G ZACHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/24/2020
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5080 N0RTH 40ST SUITE 103
PHOENIX AZ
85018-8501
US

IV. Provider business mailing address

3104 E CAMELBACK RD # 1035
PHOENIX AZ
85016-4502
US

V. Phone/Fax

Practice location:
  • Phone: 480-772-2453
  • Fax: 480-452-1123
Mailing address:
  • Phone: 480-772-2453
  • Fax: 480-452-1123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number30227
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: