Healthcare Provider Details

I. General information

NPI: 1003943259
Provider Name (Legal Business Name): MORTON ZEBRACK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74976 US HIGHWAY 111
INDIAN WELLS CA
92210-7117
US

IV. Provider business mailing address

78455 SUNRISE CANYON AVE
PALM DESERT CA
92211-2603
US

V. Phone/Fax

Practice location:
  • Phone: 760-568-4544
  • Fax: 760-568-4555
Mailing address:
  • Phone: 760-772-5149
  • Fax: 760-200-4382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA28654
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: