Provider Demographics
NPI:1073828356
Name:WILLIAM E. ZACHOW, D.O. MEDICAL CORPORATION
Entity Type:Organization
Organization Name:WILLIAM E. ZACHOW, D.O. MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
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 1:19747 GREENLEY RD
Practice Address - Street 2:SUITE S-2
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5998
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:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11228207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D47210Medicare UPIN