Healthcare Provider Details

I. General information

NPI: 1356386502
Provider Name (Legal Business Name): WILLIAM M ZELLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 CLIFT CT
HOLLISTER MO
65672-5947
US

IV. Provider business mailing address

PO BOX 505164
SAINT LOUIS MO
63150-5164
US

V. Phone/Fax

Practice location:
  • Phone: 417-336-4355
  • Fax: 417-337-5141
Mailing address:
  • Phone: 417-829-4620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR5604
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: