Healthcare Provider Details

I. General information

NPI: 1316901184
Provider Name (Legal Business Name): KEITH G. ZACHER, MD, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 N SCOTTSDALE RD STE 110
SCOTTSDALE AZ
85251-5648
US

IV. Provider business mailing address

3501 N SCOTTSDALE RD STE 110
SCOTTSDALE AZ
85251-5648
US

V. Phone/Fax

Practice location:
  • Phone: 480-945-0663
  • Fax: 480-947-3991
Mailing address:
  • Phone: 480-945-0663
  • Fax: 480-947-3991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. KEITH G. ZACHER
Title or Position: MANAGER
Credential: MD
Phone: 480-945-0663