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General NPI Number Information
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NPI Number | 1235321282
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Entity Type | Organization
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Legal Business Name | ALLERGY, EARS, NOSE AND THROAT OF PAYSON
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Dates
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Enumeration Date | 08/14/2007
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Last Update Date | 08/14/2007
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Provider Practice Location Address
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Address Line | 903 E. HWY 260
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City | PAYSON
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State | AZ
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Zip | 85541
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Country | US
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Telephone | 928-474-0500
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Fax | 928-474-3632
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Provider Business Mailing Address
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Address Line | PO BOX 1393
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City | PAYSON
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State | AZ
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Zip | 85547-1393
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Country | US
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Telephone | 928-474-0500
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Fax | 928-474-3632
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. PETER M ZONAKIS
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Credential | MD
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Telephone | 928-474-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 24125
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License Number State | AZ
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