Healthcare Provider Details

I. General information

NPI: 1245217371
Provider Name (Legal Business Name): J PETER ZEGARRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 SCRIPPS DRIVE SUITE 300
SACRAMENTO CA
95825-6504
US

IV. Provider business mailing address

87 SCRIPPS DRIVE SUITE 300
SACRAMENTO CA
95825-6504
US

V. Phone/Fax

Practice location:
  • Phone: 916-923-0620
  • Fax: 916-923-0662
Mailing address:
  • Phone: 916-923-0620
  • Fax: 916-923-0662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberG52872
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: