Healthcare Provider Details

I. General information

NPI: 1477722213
Provider Name (Legal Business Name): TIMOTHY JAMES DAVID ZWAYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 10/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2142 N COVE BLVD
TOLEDO OH
43606-3895
US

IV. Provider business mailing address

4213 MORGAN PLACE
PERRYSBURG OH
43551-2194
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-3627
  • Fax:
Mailing address:
  • Phone: 418-870-4407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number11013755
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01065642A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number095510
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: