Provider Demographics
NPI:1306818158
Name:MARK ZACHARY MD
Entity Type:Organization
Organization Name:MARK ZACHARY MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ZACHARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-843-2866
Mailing Address - Street 1:18275 N 59TH AVE
Mailing Address - Street 2:BLDG M 176
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308
Mailing Address - Country:US
Mailing Address - Phone:602-843-2866
Mailing Address - Fax:602-938-1491
Practice Address - Street 1:18275 N 59TH AVE
Practice Address - Street 2:BLDG M 176
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1260
Practice Address - Country:US
Practice Address - Phone:602-843-2866
Practice Address - Fax:602-938-1491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12879261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4207700OtherCIGNA
AZ0004670OtherBLUE CROSS BLUE SHIELD
1Z3860OtherHEALTHNET
AZ224204Medicaid
34326OtherUNITED HEALTHCARE
34326OtherUNITED HEALTHCARE
0000BGJZQMedicare ID - Type Unspecified