Provider Demographics
NPI:1093337982
Name:ANDERSON, ZACHARY STEPHEN (DO)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:STEPHEN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 MADISON AVE STE 447
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-3438
Mailing Address - Country:US
Mailing Address - Phone:901-448-5737
Mailing Address - Fax:
Practice Address - Street 1:920 MADISON AVENUE SUITE 447
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163-3503
Practice Address - Country:US
Practice Address - Phone:901-448-5737
Practice Address - Fax:901-448-7836
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO390200000X
TN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program