Healthcare Provider Details

I. General information

NPI: 1790425452
Provider Name (Legal Business Name): ZACHARY COLE DOCKTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S 5TH ST
BISMARCK ND
58504-5675
US

IV. Provider business mailing address

200 S 5TH ST
BISMARCK ND
58504-5675
US

V. Phone/Fax

Practice location:
  • Phone: 701-222-3937
  • Fax: 701-222-8805
Mailing address:
  • Phone: 701-222-3937
  • Fax: 701-222-8805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number23955
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: