Provider Demographics
NPI:1164530200
Name:ZEIGLER, JASON C (DPM)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:C
Last Name:ZEIGLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76764 LANCELOT CT
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-7103
Mailing Address - Country:US
Mailing Address - Phone:760-200-8588
Mailing Address - Fax:
Practice Address - Street 1:3303 HEALY DR STE B
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1569
Practice Address - Country:US
Practice Address - Phone:336-768-8848
Practice Address - Fax:336-768-3078
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC459213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890807VMedicaid
NCU90576Medicare UPIN
NC890807VMedicaid