Provider Demographics
NPI:1891798211
Name:ZUROSKE, GLEN W (MD)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:W
Last Name:ZUROSKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1110 GILLMORE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3302
Mailing Address - Country:US
Mailing Address - Phone:509-943-1172
Mailing Address - Fax:509-946-6278
Practice Address - Street 1:1110 GILMORE ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3302
Practice Address - Country:US
Practice Address - Phone:509-943-1172
Practice Address - Fax:509-946-6278
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027215207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA060018878OtherRR MC
WA7069735Medicaid
WA7069735Medicaid
E22715Medicare UPIN