Provider Demographics
NPI:1225018856
Name:ZWART, ALEXANDER DOMINICUS (MD, FACP)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:DOMINICUS
Last Name:ZWART
Suffix:
Gender:M
Credentials:MD, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43160
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85733-3160
Mailing Address - Country:US
Mailing Address - Phone:520-297-0404
Mailing Address - Fax:520-297-0436
Practice Address - Street 1:5910 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3535
Practice Address - Country:US
Practice Address - Phone:520-297-0404
Practice Address - Fax:520-297-0436
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23182207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ315160Medicaid
F64593Medicare UPIN
AZ315160Medicaid