Provider Demographics
NPI:1033101365
Name:ZAHARA, MARK W (PT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:W
Last Name:ZAHARA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1111
Mailing Address - Country:US
Mailing Address - Phone:205-327-5030
Mailing Address - Fax:205-327-5616
Practice Address - Street 1:820 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1111
Practice Address - Country:US
Practice Address - Phone:205-327-5030
Practice Address - Fax:205-327-5616
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH 3301204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51505107OtherBLUE CROSS
ALPTH 3301Medicare UPIN