Healthcare Provider Details

I. General information

NPI: 1992931711
Provider Name (Legal Business Name): ZACHARY FISK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 116TH AVE NE
BELLEVUE WA
98004-3817
US

IV. Provider business mailing address

1310 116TH AVE NE
BELLEVUE WA
98004-3817
US

V. Phone/Fax

Practice location:
  • Phone: 425-440-3351
  • Fax: 425-440-3439
Mailing address:
  • Phone: 425-440-3351
  • Fax: 425-440-3439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number60491842
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD60491842
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: