Healthcare Provider Details

I. General information

NPI: 1407958911
Provider Name (Legal Business Name): MICHAEL A ZINSER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 TIETON DR
YAKIMA WA
98902-3761
US

IV. Provider business mailing address

701 GOLF VIEW DR
MEDFORD OR
97504-9643
US

V. Phone/Fax

Practice location:
  • Phone: 509-575-8000
  • Fax: 509-225-2715
Mailing address:
  • Phone: 541-494-1111
  • Fax: 541-494-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10002489
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number210
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA184071
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: