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General NPI Number Information
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NPI Number | 1356460018
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Entity Type | Individual
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Provider Name | MARK J ZALLA M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 12/04/2009
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Provider Practice Location Address
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Address Line | 7766 EWING BLVD STE 100
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City | FLORENCE
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State | KY
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Zip | 41042-7538
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Country | US
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Telephone | 859-283-1033
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Fax | 859-283-1066
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Provider Business Mailing Address
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Address Line | 7766 EWING BLVD STE 100
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City | FLORENCE
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State | KY
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Zip | 41042-7538
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Country | US
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Telephone | 859-283-1033
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Fax | 859-283-1066
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 35119
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 35119
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | K35119
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License Number State | KY
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