=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558343871
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GREGG STEVEN ZANKMAN D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2005
-----------------------------------------------------
Last Update Date | 10/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 S POWER RD STE 106
-----------------------------------------------------
City | MESA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85206-5236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-214-0051
-----------------------------------------------------
Fax | 480-214-0055
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 S POWER RD STE 106
-----------------------------------------------------
City | MESA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85206-5236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-214-0051
-----------------------------------------------------
Fax | 480-214-0055
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 20A15798
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 3618
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------