Healthcare Provider Details

I. General information

NPI: 1891798211
Provider Name (Legal Business Name): GLEN W ZUROSKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 GILMORE ST
RICHLAND WA
99352-3302
US

IV. Provider business mailing address

1110 GILLMORE AVE
RICHLAND WA
99352-3302
US

V. Phone/Fax

Practice location:
  • Phone: 509-943-1172
  • Fax: 509-946-6278
Mailing address:
  • Phone: 509-943-1172
  • Fax: 509-946-6278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD00027215
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: