Provider Demographics
NPI:1043320484
Name:ZARAGOZA, EMILY J (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:J
Last Name:ZARAGOZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1100 FAIRVIEW AVE N # ME-B220
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-4433
Mailing Address - Country:US
Mailing Address - Phone:602-667-3154
Mailing Address - Fax:206-667-2273
Practice Address - Street 1:11729 ROE AVE
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-2605
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:401-652-9093
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31672207Q00000X
KS04-41400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ815631Medicaid
AZ815631Medicaid
AZZ165433Medicare PIN