Healthcare Provider Details

I. General information

NPI: 1013584127
Provider Name (Legal Business Name): ZACHARY SCOTT BARLOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 FAIRVIEW LN
SONORA CA
95370-4828
US

IV. Provider business mailing address

902 LAKEVIEW AVE
PUEBLO CO
81004-3597
US

V. Phone/Fax

Practice location:
  • Phone: 209-536-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA198378
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: