Healthcare Provider Details

I. General information

NPI: 1699727453
Provider Name (Legal Business Name): ALLEN JEFFREY ZAGOREN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 PLEASANT ST SUITE 308
DES MOINES IA
50309-1416
US

IV. Provider business mailing address

1215 PLEASANT ST STE 308
DES MOINES IA
50309-1409
US

V. Phone/Fax

Practice location:
  • Phone: 515-241-4325
  • Fax:
Mailing address:
  • Phone: 515-241-4325
  • Fax: 515-241-6138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDO-01906
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: