Provider Demographics
NPI: | 1619911005 |
---|---|
Name: | ZEHR, BRIAN P (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | BRIAN |
Middle Name: | P |
Last Name: | ZEHR |
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: | 11109 PARKVIEW PLAZA DR # 117 |
Mailing Address - Street 2: | |
Mailing Address - City: | FORT WAYNE |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 46845-1701 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 11104 PARKVIEW CIRCLE DR STE 10 |
Practice Address - Street 2: | |
Practice Address - City: | FORT WAYNE |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46845-1733 |
Practice Address - Country: | US |
Practice Address - Phone: | 260-425-6800 |
Practice Address - Fax: | 260-425-6845 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-06-15 |
Last Update Date: | 2022-10-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IN | 01032028 | 207RP1001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IN | 100355500 | Medicaid | |
OH | 0808522 | Medicaid | |
IN | P00685780 | Other | RR MEDICARE |
IN | 000000576544 | Other | ANTHEM |
IN | P00685780 | Other | RR MEDICARE |
OH | 0808522 | Medicaid | |
IN | 925060BB | Medicare PIN |