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NPI Code Detail

MEDICARE: DR. CHARLES JEFFREY ZOLLINGER M.D.

MEDICARE: DR. CHARLES JEFFREY ZOLLINGER 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
1208D00000XGeneral Practice PhysicianM4211ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629182282
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES JEFFREY ZOLLINGER M.D.
Provider Business Mailing Address
First Line : 393 E 2ND N
Second Line :
City : REXBURG
State : ID
Zip : 83440-1605
Country : US
Telephone Number : 208-356-5401
Fax Number : 208-356-3111
Provider Business Practice Location Address
First Line : 393 E 2ND N
Second Line :
City : REXBURG
State : ID
Zip : 83440-1605
Country : US
Telephone Number : 208-356-5401
Fax Number : 208-356-3111
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2006
Last Update Date : 04/14/2020

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