Healthcare Provider Details

I. General information

NPI: 1578640918
Provider Name (Legal Business Name): MATTHEW B ZAVOD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 COTTONWOOD ST SUITE 205
WOODLAND CA
95695-5131
US

IV. Provider business mailing address

1321 COTTONWOOD ST SUITE 205
WOODLAND CA
95695-5131
US

V. Phone/Fax

Practice location:
  • Phone: 530-666-1631
  • Fax: 530-406-0352
Mailing address:
  • Phone: 530-666-1631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA95031
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberA95031
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: