Provider Demographics
NPI:1609852441
Name:ZAMORA, JACK ANDERSON (MD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:ANDERSON
Last Name:ZAMORA
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 1:36 STEELE STREET
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206
Mailing Address - Country:US
Mailing Address - Phone:303-780-7377
Mailing Address - Fax:866-420-2197
Practice Address - Street 1:3773 CHERRY CREEK NORTH DR
Practice Address - Street 2:SUITE 140
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3814
Practice Address - Country:US
Practice Address - Phone:303-780-7377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA215374207W00000X
CO42961207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO181542901OtherRAILROAD MEDICARE
CO78134765Medicaid
CO181542901OtherRAILROAD MEDICARE
H65657Medicare UPIN