Provider Demographics
NPI:1447412929
Name:BASTIAN, ZACHARY N (MD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:N
Last Name:BASTIAN
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 1:1024 E LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-2776
Mailing Address - Country:US
Mailing Address - Phone:208-365-2338
Mailing Address - Fax:208-365-0677
Practice Address - Street 1:1024 E LOCUST ST
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-2776
Practice Address - Country:US
Practice Address - Phone:208-365-2338
Practice Address - Fax:208-365-0677
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRL10648208600000X
ND12284208600000X
ORMD165259208600000X
IDM-12152208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery