Provider Demographics
NPI:1942482575
Name:ZACHARY, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:ZACHARY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18275 N 59TH AVE
Mailing Address - Street 2:BLDG M #176
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1260
Mailing Address - Country:US
Mailing Address - Phone:602-843-2866
Mailing Address - Fax:602-938-1491
Practice Address - Street 1:18275 N 59TH AVE
Practice Address - Street 2:BLDG M #176
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1260
Practice Address - Country:US
Practice Address - Phone:602-843-2866
Practice Address - Fax:602-938-1491
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ12879207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1Z3860OtherHEALTHNET
AZ0467420OtherAETNA
AZ224204Medicaid
AZ34326OtherUHC
AZAZ0004670OtherBLUE CROSS BLUE SHIELD
AZ34326OtherUHC
AZ0881090002Medicare NSC
AZAZ0004670OtherBLUE CROSS BLUE SHIELD