MEDICARE: CONNIE D ZAPF PA-C

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	363AM0700X	Medical Physician Assistant	50001397	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00011729	OTHER	OH	MEDICARE RAILROAD

General Provider Information

NPI Number	:	1528049632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNIE D ZAPF PA-C

Provider Business Mailing Address
First Line	:	2400 W STROOP RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45439-2041
Country	:	US
Telephone Number	:	937-298-4709
Fax Number	:	937-298-6062

Provider Business Practice Location Address
First Line	:	2400 W STROOP RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45439-2007
Country	:	US
Telephone Number	:	937-298-4709
Fax Number	:	937-298-6062

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	12/06/2007

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