Healthcare Provider Details

I. General information

NPI: 1083606834
Provider Name (Legal Business Name): PETER ZONAKIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 POLE LINE RD W STE 2B
TWIN FALLS ID
83301-4270
US

IV. Provider business mailing address

501 AIRPORT RD
RIFLE CO
81650-8510
US

V. Phone/Fax

Practice location:
  • Phone: 208-814-7350
  • Fax: 208-732-8508
Mailing address:
  • Phone: 970-625-1100
  • Fax: 970-625-0725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number52045
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number4971546
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: