Provider Demographics
NPI:1407283922
Name:KOBAN, ZAKERY AUSTIN (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:ZAKERY
Middle Name:AUSTIN
Last Name:KOBAN
Suffix:
Gender:M
Credentials:MPAS, PA-C
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3106 TEE CT
Mailing Address - Street 2:
Mailing Address - City:PRESTO
Mailing Address - State:PA
Mailing Address - Zip Code:15142-1502
Mailing Address - Country:US
Mailing Address - Phone:814-341-0259
Mailing Address - Fax:724-933-1810
Practice Address - Street 1:14000 PERRY HWY
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8442
Practice Address - Country:US
Practice Address - Phone:724-933-1800
Practice Address - Fax:724-933-1810
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-29
Last Update Date:2013-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA054426363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical