Provider Demographics
NPI:1639326010
Name:SELF, ZACHARY B (MD)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:B
Last Name:SELF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3030 COVINGTON PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-5048
Mailing Address - Country:US
Mailing Address - Phone:901-383-8889
Mailing Address - Fax:901-383-2245
Practice Address - Street 1:3030 COVINGTON PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-5048
Practice Address - Country:US
Practice Address - Phone:901-383-8889
Practice Address - Fax:901-383-2245
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2016-11-22
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Provider Licenses
StateLicense IDTaxonomies
TN46790207Q00000X, 207VX0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics