Provider Demographics
NPI:1508828781
Name:ZIGLAR, JERRY THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:THOMAS
Last Name:ZIGLAR
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2000 FRONTIS PLAZA BLVD STE 200
Mailing Address - Street 2:(ATTN) FORSYTH MEDICAL GROUP
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5616
Mailing Address - Country:US
Mailing Address - Phone:336-277-2435
Mailing Address - Fax:336-679-7056
Practice Address - Street 1:305 E LEE AVE
Practice Address - Street 2:DBA YADKIN MEDICAL ASSOCIATES
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-8132
Practice Address - Country:US
Practice Address - Phone:336-679-2661
Practice Address - Fax:336-679-7056
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC25101207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8989921Medicaid
NCC81538Medicare UPIN
NC8989921Medicaid