Provider Demographics
NPI:1407958911
Name:ZINSER, MICHAEL A (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:ZINSER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 GOLF VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9643
Mailing Address - Country:US
Mailing Address - Phone:541-494-1111
Mailing Address - Fax:541-494-1099
Practice Address - Street 1:2811 TIETON DR
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3761
Practice Address - Country:US
Practice Address - Phone:509-575-8000
Practice Address - Fax:509-225-2715
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10002489363AM0700X
MT210363AS0400X
ORPA184071363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4306083Medicaid
MT000084818Medicare ID - Type Unspecified
MT96503OtherBLUE CROSS BLUE SHIELD
MTS32518Medicare UPIN