Provider Demographics
NPI:1497766224
Name:ZOLTANI, JOHN GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GREGORY
Last Name:ZOLTANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:J
Other - Middle Name:GREG
Other - Last Name:ZOLTANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 88907
Mailing Address - Street 2:
Mailing Address - City:STEILACOOM
Mailing Address - State:WA
Mailing Address - Zip Code:98388-0500
Mailing Address - Country:US
Mailing Address - Phone:253-581-8151
Mailing Address - Fax:253-581-8152
Practice Address - Street 1:7502 LAKEWOOD DR W
Practice Address - Street 2:SUITE C-7
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-8410
Practice Address - Country:US
Practice Address - Phone:253-581-8151
Practice Address - Fax:253-581-8152
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000271392084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0062048OtherL & I
WA1056415Medicaid
WA1056415Medicaid
WA0062048OtherL & I
AZ2849353OtherDEA