=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023205044
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLIAM E. ZACHOW D.O., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2007
-----------------------------------------------------
Last Update Date | 11/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7802 N 43RD AVE SUITE # 5
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85301-8111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-790-4221
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3009
-----------------------------------------------------
City | SONORA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95370-3009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-790-4221
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/PHYSICIAN
-----------------------------------------------------
Name | DR. WILLIAM EUGENE ZACHOW
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 602-790-4221
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 2324
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------