Provider Demographics
NPI:1003943259
Name:ZEBRACK, MORTON (MD)
Entity Type:Individual
Prefix:
First Name:MORTON
Middle Name:
Last Name:ZEBRACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78455 SUNRISE CANYON AVE
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-2603
Mailing Address - Country:US
Mailing Address - Phone:760-772-5149
Mailing Address - Fax:760-200-4382
Practice Address - Street 1:74976 US HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:INDIAN WELLS
Practice Address - State:CA
Practice Address - Zip Code:92210-7117
Practice Address - Country:US
Practice Address - Phone:760-568-4544
Practice Address - Fax:760-568-4555
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA28654208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00296004OtherRAILROAD PIN #
CA00A286540OtherBLUE SHIELD OF CALIFORNIA
P00296004OtherRAILROAD PIN #
CA00A286541Medicare PIN