Healthcare Provider Details

I. General information

NPI: 1659529212
Provider Name (Legal Business Name): ZACHARY DAVID TORRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CAMINO ALTO SUITE 204
MILL VALLEY CA
94941-2929
US

IV. Provider business mailing address

45 CAMINO ALTO SUITE 204
MILL VALLEY CA
94941-2929
US

V. Phone/Fax

Practice location:
  • Phone: 650-458-7407
  • Fax: 650-458-0403
Mailing address:
  • Phone: 650-458-7407
  • Fax: 650-458-0403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number255403
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA113782
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD439970
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: