Healthcare Provider Details

I. General information

NPI: 1457304099
Provider Name (Legal Business Name): HAZEM ZEKRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 MEDICAL CENTER CT
CHULA VISTA CA
91911-6617
US

IV. Provider business mailing address

1801 N WALNUT ST
MUNCIE IN
47303-1953
US

V. Phone/Fax

Practice location:
  • Phone: 619-482-5800
  • Fax:
Mailing address:
  • Phone: 765-284-0493
  • Fax: 765-213-3240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA77276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: