Healthcare Provider Details

I. General information

NPI: 1619965530
Provider Name (Legal Business Name): ZACHARY NEWLAND D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 02/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4585 WASHINGTON ST SUITE A2
FLORISSANT MO
63033-5858
US

IV. Provider business mailing address

4585 WASHINGTON ST SUITE A2
FLORISSANT MO
63033-5858
US

V. Phone/Fax

Practice location:
  • Phone: 314-972-1040
  • Fax: 314-972-1055
Mailing address:
  • Phone: 314-972-1040
  • Fax: 314-972-1055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number519
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: