Provider Demographics
NPI:1407955008
Name:ZACK, DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:ZACK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4841 MONROE ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4385
Mailing Address - Country:US
Mailing Address - Phone:419-471-1317
Mailing Address - Fax:419-471-1316
Practice Address - Street 1:4841 MONROE ST
Practice Address - Street 2:SUITE 110
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4385
Practice Address - Country:US
Practice Address - Phone:419-471-1317
Practice Address - Fax:419-471-1316
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34006071207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology