Provider Demographics
NPI:1861499071
Name:ZUECH, DAVID E (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:ZUECH
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 1:615 E OKLAHOMA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5951
Mailing Address - Country:US
Mailing Address - Phone:580-233-4711
Mailing Address - Fax:580-234-6686
Practice Address - Street 1:615 E OKLAHOMA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5951
Practice Address - Country:US
Practice Address - Phone:580-233-4711
Practice Address - Fax:580-234-6686
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19329174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK180029022OtherRAILROAD MEDICARE
OK0748750001OtherCIGNA DMERC
OK100729900AMedicaid
OK100729900AMedicaid
OK100729900AMedicaid