Provider Demographics
NPI:1326029026
Name:ZACHER, KEITH G (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:G
Last Name:ZACHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3104 E CAMELBACK RD # 1035
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4502
Mailing Address - Country:US
Mailing Address - Phone:480-772-2453
Mailing Address - Fax:480-452-1123
Practice Address - Street 1:5080 N0RTH 40ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-8501
Practice Address - Country:US
Practice Address - Phone:480-772-2453
Practice Address - Fax:480-452-1123
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ30227208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ695728Medicaid
AZ695728Medicaid
AZZ111890Medicare PIN
AZZ111890Medicare PIN