MEDICARE: DR. RON ZUIDERWEG D.O.

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	207RN0300X	Nephrology Physician	4370	AZ
2	207RN0300X	Nephrology Physician	13277025-1204	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4370	OTHER	AZ	AZ MEDICAL LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386680387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RON ZUIDERWEG D.O.

Provider Business Mailing Address
First Line	:	3702 S STATE ST STE 107
Second Line	:
City	:	SOUTH SALT LAKE
State	:	UT
Zip	:	84115-5096
Country	:	US
Telephone Number	:	801-288-2634
Fax Number	:	801-288-1186

Provider Business Practice Location Address
First Line	:	5285 S 400 E STE B
Second Line	:
City	:	WASHINGTON TERRACE
State	:	UT
Zip	:	84405-7194
Country	:	US
Telephone Number	:	801-779-3500
Fax Number	:	801-779-3508

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

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	05/09/2024

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