Provider Demographics
NPI:1740232610
Name:WILEY, ZEALOUS D JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ZEALOUS
Middle Name:D
Last Name:WILEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3300 WEBSTER STREET
Mailing Address - Street 2:SUITE 312
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94116
Mailing Address - Country:US
Mailing Address - Phone:510-444-3297
Mailing Address - Fax:510-444-6421
Practice Address - Street 1:3300 WEBSTER STREET
Practice Address - Street 2:SUITE 312
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94116
Practice Address - Country:US
Practice Address - Phone:510-444-3297
Practice Address - Fax:510-444-6421
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC33824207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0082090Medicaid
CAZZZ23860ZMedicare ID - Type Unspecified
CA00C338243Medicare PIN
A35390Medicare UPIN