Healthcare Provider Details

I. General information

NPI: 1275806721
Provider Name (Legal Business Name): ZACHARY STEPHEN NEUBERT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 MONTGOMERY BLVD NE STE 201
ALBUQUERQUE NM
87109-1233
US

IV. Provider business mailing address

98-211 PALI MOMI ST STE 312
AIEA HI
96701-4306
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-7833
  • Fax:
Mailing address:
  • Phone: 808-486-0449
  • Fax: 808-756-9552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number92569
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberDOS-2091
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number1117
License Number StateNE
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberDO2025-0019
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: