Provider Demographics
NPI:1013925767
Name:ANDERSON, ZACHARY JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:JOHN
Last Name:ANDERSON
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 1:90 MADISON ST
Mailing Address - Street 2:SUITE 504
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5418
Mailing Address - Country:US
Mailing Address - Phone:720-524-1550
Mailing Address - Fax:720-524-1551
Practice Address - Street 1:90 MADISON ST
Practice Address - Street 2:SUITE 504
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5418
Practice Address - Country:US
Practice Address - Phone:720-524-1550
Practice Address - Fax:720-524-1551
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01208207Q00000X, 208M00000X
CO43334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO75880849Medicaid
NC5901660Medicaid
COI40624Medicare UPIN
NC2045753Medicare ID - Type Unspecified
NC5901660Medicaid