Healthcare Provider Details

I. General information

NPI: 1962842955
Provider Name (Legal Business Name): RICHARD JOHN ZOGALA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 28 1/4 RD
GRAND JUNCTION CO
81506
US

IV. Provider business mailing address

PO BOX 1727
GRAND JUNCTION CO
81502-1727
US

V. Phone/Fax

Practice location:
  • Phone: 970-644-3840
  • Fax: 970-644-3916
Mailing address:
  • Phone: 970-263-2619
  • Fax: 970-263-2691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberDR.0061360
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: