Healthcare Provider Details

I. General information

NPI: 1528023934
Provider Name (Legal Business Name): ZACKWRIE S PARR D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 KANELL BLVD SUITE 201
POPLAR BLUFF MO
63901-4045
US

IV. Provider business mailing address

4061 HIGHWAY PP
POPLAR BLUFF MO
63901-3967
US

V. Phone/Fax

Practice location:
  • Phone: 573-785-4959
  • Fax: 573-785-6405
Mailing address:
  • Phone: 573-778-0020
  • Fax: 573-778-1647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000617
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: