Provider Demographics
NPI:1790746006
Name:ZAKALUZNY, SCOTT ADRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ADRIAN
Last Name:ZAKALUZNY
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 1:101 BODIN CIR 60 MDG/SGCQ
Mailing Address - Street 2:
Mailing Address - City:TRAVIS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:94535-1800
Mailing Address - Country:US
Mailing Address - Phone:707-423-5179
Mailing Address - Fax:
Practice Address - Street 1:101 BODIN CIR 60 MDG/SGCQ
Practice Address - Street 2:
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535-1800
Practice Address - Country:US
Practice Address - Phone:707-423-5179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1162542086S0102X, 208600000X
IN01059505A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care