Healthcare Provider Details

I. General information

NPI: 1063355196
Provider Name (Legal Business Name): DAMARCUS ZACHERY PSS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1966 GARDEN AVE
EUGENE OR
97403-1933
US

IV. Provider business mailing address

1966 GARDEN AVE
EUGENE OR
97403-1933
US

V. Phone/Fax

Practice location:
  • Phone: 541-505-9190
  • Fax:
Mailing address:
  • Phone: 541-505-9190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberTHW000115736
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: