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General NPI Number Information
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NPI Number | 1306818158
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Entity Type | Organization
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Legal Business Name | MARK ZACHARY MD
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Dates
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Enumeration Date | 02/06/2006
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Last Update Date | 12/07/2007
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Provider Practice Location Address
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Address Line | 18275 N 59TH AVE BLDG M 176
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City | GLENDALE
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State | AZ
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Zip | 85308-1260
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Country | US
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Telephone | 602-843-2866
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Fax | 602-938-1491
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Provider Business Mailing Address
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Address Line | 18275 N 59TH AVE BLDG M 176
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City | GLENDALE
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State | AZ
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Zip | 85308
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Country | US
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Telephone | 602-843-2866
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Fax | 602-938-1491
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Authorized Official
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Title or Position | ORTHOPEDIC SURGEON
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Name | MARK ZACHARY
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Credential | M.D.
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Telephone | 602-843-2866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 12879
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License Number State | AZ
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