Healthcare Provider Details

I. General information

NPI: 1942296371
Provider Name (Legal Business Name): JORGE O ZAPATA MD INC PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 04/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9750 LEVIN RD NW
SILVERDALE WA
98383-8399
US

IV. Provider business mailing address

9750 LEVIN RD NW
SILVERDALE WA
98383-8399
US

V. Phone/Fax

Practice location:
  • Phone: 360-307-7202
  • Fax: 360-698-6600
Mailing address:
  • Phone: 360-307-7202
  • Fax: 360-698-6600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD00016403
License Number StateWA

VIII. Authorized Official

Name: DR. JORGE O ZAPATA
Title or Position: OWNER
Credential: M.D.
Phone: 360-307-7202