Provider Demographics
NPI:1356829774
Name:KLEINPETER, ZACHARY ALLEN RUNGE (PA-C)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:ALLEN RUNGE
Last Name:KLEINPETER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:ZACHARY
Other - Middle Name:ALLEN
Other - Last Name:RUNGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1111 MEDICAL CENTER BLVD STE S750
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3197
Mailing Address - Country:US
Mailing Address - Phone:504-340-6976
Mailing Address - Fax:
Practice Address - Street 1:1111 MEDICAL CENTER BLVD STE S630
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072
Practice Address - Country:US
Practice Address - Phone:504-934-8320
Practice Address - Fax:504-934-8940
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA310190363AS0400X, 363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical