Provider Demographics
NPI:1447233572
Name:ZINKE, JOHN D (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:ZINKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 877
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA
Mailing Address - State:CA
Mailing Address - Zip Code:93428-0877
Mailing Address - Country:US
Mailing Address - Phone:805-748-1076
Mailing Address - Fax:
Practice Address - Street 1:588 HUNTINGTON RD
Practice Address - Street 2:
Practice Address - City:CAMBRIA
Practice Address - State:CA
Practice Address - Zip Code:93428-3606
Practice Address - Country:US
Practice Address - Phone:805-748-1076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35716208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
7675408OtherAETNA
CA00G357160OtherBLUE SHIELD OF CALIFORNIA
080187431Medicare PIN
CAFM497BMedicare PIN
CA00G357160OtherBLUE SHIELD OF CALIFORNIA
CAA02105Medicare UPIN
CAWG35716KMedicare PIN