=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962479477
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MOUNIR GEORGE ZAKHARY MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 304 S PARK LN SUITE B
-----------------------------------------------------
City | ALTUS
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73521-5718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-477-7444
-----------------------------------------------------
Fax | 580-477-7452
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 975
-----------------------------------------------------
City | ALTUS
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73522-0975
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-477-7444
-----------------------------------------------------
Fax | 580-477-7452
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | 16307
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------