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General NPI Number Information
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NPI Number | 1720091465
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Entity Type | Individual
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Provider Name | IVAN A ZAMORA MD
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Gender | Male
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4011 TALBOT RD S STE 420
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City | RENTON
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State | WA
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Zip | 98055-5773
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Country | US
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Telephone | 425-656-5430
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Fax |
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Provider Business Mailing Address
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Address Line | 3600 LIND AVE SW STE 100
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City | RENTON
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State | WA
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Zip | 98055-4934
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Country | US
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Telephone | 425-656-5412
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Fax |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD00016577
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License Number State | WA
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