Healthcare Provider Details

I. General information

NPI: 1295772291
Provider Name (Legal Business Name): GARY MICHAEL ZEIGLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SE COURT AVENUE
PENDLETON OR
97801-3217
US

IV. Provider business mailing address

505 S 336TH STREET SUITE 600
FEDERAL WAY WA
98003-6328
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-5121
  • Fax: 541-278-3661
Mailing address:
  • Phone: 253-838-6180
  • Fax: 253-838-6418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD23743
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: