Provider Demographics
NPI:1689232290
Name:STODDARD, ZARREN
Entity Type:Individual
Prefix:
First Name:ZARREN
Middle Name:
Last Name:STODDARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 REBECCAS WAY
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-7588
Mailing Address - Country:US
Mailing Address - Phone:208-946-1486
Mailing Address - Fax:
Practice Address - Street 1:108 REBECCAS WAY
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-7588
Practice Address - Country:US
Practice Address - Phone:208-946-1486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program