Provider Demographics
NPI:1225084890
Name:GARY B ZOELLNER MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:GARY B ZOELLNER MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:ZOELLNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-726-5054
Mailing Address - Street 1:1501 W 24TH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6370
Mailing Address - Country:US
Mailing Address - Phone:928-726-5054
Mailing Address - Fax:928-314-0885
Practice Address - Street 1:1501 W 24TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6370
Practice Address - Country:US
Practice Address - Phone:928-726-5054
Practice Address - Fax:928-314-0885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30437207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A52112Medicare UPIN
AZ102311Medicare PIN
AZZ101519Medicare ID - Type Unspecified
AZ102310Medicare PIN