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General NPI Number Information
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NPI Number | 1619959145
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Entity Type | Individual
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Provider Name | GREGORY STANLEY ZOLKOWSKI DO
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Gender | Male
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Dates
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Enumeration Date | 11/18/2005
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Last Update Date | 03/13/2020
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Provider Practice Location Address
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Address Line | 910 E SAN MARTIN ST
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City | BOLIVAR
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State | MO
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Zip | 65613-2893
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Country | US
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Telephone | 417-777-4749
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Fax | 417-777-8041
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Provider Business Mailing Address
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Address Line | PO BOX 536
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City | BOLIVAR
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State | MO
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Zip | 65613-0536
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Country | US
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Telephone | 417-777-4749
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Fax | 417-777-8041
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | E-11776
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E-11776
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 101186
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License Number State | MO
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