Provider Demographics
NPI:1023205044
Name:WILLIAM E. ZACHOW D.O., P.C.
Entity Type:Organization
Organization Name:WILLIAM E. ZACHOW D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:ZACHOW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-790-4221
Mailing Address - Street 1:PO BOX 3009
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-3009
Mailing Address - Country:US
Mailing Address - Phone:602-790-4221
Mailing Address - Fax:
Practice Address - Street 1:7802 N 43RD AVE
Practice Address - Street 2:SUITE # 5
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-8111
Practice Address - Country:US
Practice Address - Phone:602-790-4221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2324261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ282947Medicaid
AZ282947Medicaid