Provider Demographics
NPI:1508889551
Name:ZAKA, SAFOORA (MD)
Entity Type:Individual
Prefix:
First Name:SAFOORA
Middle Name:
Last Name:ZAKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 WHEATON WAY
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3399
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:450 S KITSAP BLVD
Practice Address - Street 2:SUITE 2860
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3773
Practice Address - Country:US
Practice Address - Phone:360-782-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046807207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8459091Medicaid
WA211617OtherLABOR & INDUSTRIES
7573855OtherAETNA
WA8918AZOtherREGENCE BLUE SHIELD
WAG8861547Medicare PIN
WA8918AZOtherREGENCE BLUE SHIELD
WAG8861546Medicare PIN
WAG8864756Medicare PIN
7573855OtherAETNA