MEDICARE: DR. JUDY L. ZACHER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	01054348A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000381394	OTHER	IN	ANTHEM PIN NUMBER
2	1919896	OTHER	IN	FIRST HEALTH/COVENTRY

General Provider Information

NPI Number	:	1124063102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDY L. ZACHER M.D.

Provider Business Mailing Address
First Line	:	3974 NEW VISION DRIVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1712
Country	:	US
Telephone Number	:	260-471-5980
Fax Number	:	260-471-5981

Provider Business Practice Location Address
First Line	:	3974 NEW VISION DRIVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1712
Country	:	US
Telephone Number	:	260-471-5980
Fax Number	:	260-471-5981

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	05/23/2008

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