Provider Demographics
NPI:1235549932
Name:MIGEL, ZACHARY T (PA)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:T
Last Name:MIGEL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:740 S WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-5285
Mailing Address - Country:US
Mailing Address - Phone:208-542-9111
Mailing Address - Fax:208-542-9114
Practice Address - Street 1:47 DOC PERKES RD
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:WY
Practice Address - Zip Code:83110-7703
Practice Address - Country:US
Practice Address - Phone:307-885-3637
Practice Address - Fax:307-885-3638
Is Sole Proprietor?:No
Enumeration Date:2014-05-02
Last Update Date:2020-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAPA60463399363A00000X
WYPA799363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYPA799OtherSTATE