Provider Demographics
NPI:1093823775
Name:ZEGARRA, RICHARD FREDERICK II (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:FREDERICK
Last Name:ZEGARRA
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 WILSON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-2751
Mailing Address - Country:US
Mailing Address - Phone:812-532-2700
Mailing Address - Fax:812-537-1507
Practice Address - Street 1:600 WILSON CREEK RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-2751
Practice Address - Country:US
Practice Address - Phone:812-532-2700
Practice Address - Fax:812-537-1507
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047382A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
930075300OtherMEDICARE RAILROAD
000000076354OtherANTHEM
KY64343825Medicaid
G62648Medicare UPIN
KY64343825Medicaid
940340NNMedicare ID - Type Unspecified
940340NNMedicare PIN