Healthcare Provider Details

I. General information

NPI: 1427779628
Provider Name (Legal Business Name): ZACHARIAH DYNES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5630 READ BLVD
NEW ORLEANS LA
70127-3106
US

IV. Provider business mailing address

600 S SHORE DR
WINDOM MN
56101-3602
US

V. Phone/Fax

Practice location:
  • Phone: 504-493-6723
  • Fax:
Mailing address:
  • Phone: 507-822-9121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number347108
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2022035594
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: