Provider Demographics
NPI:1992019368
Name:ZASTROW, RALPH ARNOLD (IDC)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:ARNOLD
Last Name:ZASTROW
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 WALKER ST
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410-5540
Mailing Address - Country:US
Mailing Address - Phone:775-745-3274
Mailing Address - Fax:
Practice Address - Street 1:275 WALKER ST
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-5540
Practice Address - Country:US
Practice Address - Phone:775-745-3274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman