Provider Demographics
NPI:1225352032
Name:ARLAN G. ZASTROW, MD, LLC
Entity Type:Organization
Organization Name:ARLAN G. ZASTROW, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZASTROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-673-0968
Mailing Address - Street 1:320 NW MEDICAL LOOP
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-1645
Mailing Address - Country:US
Mailing Address - Phone:541-673-0968
Mailing Address - Fax:541-673-0080
Practice Address - Street 1:320 NW MEDICAL LOOP
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1645
Practice Address - Country:US
Practice Address - Phone:541-673-0968
Practice Address - Fax:541-673-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD11889261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR004390000OtherBLUE CROSS BLUE SHIELD
OR3041437OtherPACIFIC SOURCE
OR217539Medicaid
ORP00000069994OtherODS
ORP00000069994OtherODS
OR004390000OtherBLUE CROSS BLUE SHIELD