Provider Demographics
NPI:1396859229
Name:ZACHARY, MARCUS D (DO)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:D
Last Name:ZACHARY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5410 MARYLAND WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5064
Mailing Address - Country:US
Mailing Address - Phone:615-377-5670
Mailing Address - Fax:615-377-1678
Practice Address - Street 1:900 HYDE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4806
Practice Address - Country:US
Practice Address - Phone:415-353-6817
Practice Address - Fax:415-353-6887
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A8112207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX81120Medicaid
CA020A81120OtherSAN FRANCISCO BLUE SHIELD OF CALIFORNIA
020A81123Medicare PIN
CA00AX81120Medicaid