Healthcare Provider Details

I. General information

NPI: 1588695753
Provider Name (Legal Business Name): ARTHUR DAVID ZACCO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 E WILLIAMS ST
APEX NC
27502-2149
US

IV. Provider business mailing address

410 E WILLIAMS ST
APEX NC
27502-2149
US

V. Phone/Fax

Practice location:
  • Phone: 919-362-5089
  • Fax: 919-362-0071
Mailing address:
  • Phone: 919-362-5089
  • Fax: 919-362-0071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9600789
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier898985F
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: