Healthcare Provider Details

I. General information

NPI: 1114928058
Provider Name (Legal Business Name): ARLAN GEORGE ZASTROW M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 NW MEDICAL LOOP
ROSEBURG OR
97471-1645
US

IV. Provider business mailing address

320 NW MEDICAL LOOP
ROSEBURG OR
97471-1645
US

V. Phone/Fax

Practice location:
  • Phone: 541-673-0968
  • Fax: 541-673-0080
Mailing address:
  • Phone: 541-673-0968
  • Fax: 541-673-0080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMD11889
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: