Provider Demographics
NPI:1013943836
Name:ZACHARY, CHRISTOPHER BRANSBY (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:BRANSBY
Last Name:ZACHARY
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 1:101 THE CITY DR S
Mailing Address - Street 2:RT 81, BLDG 53, ROOM 205D
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3201
Mailing Address - Country:US
Mailing Address - Phone:714-456-5131
Mailing Address - Fax:714-456-6371
Practice Address - Street 1:1 MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92697-0001
Practice Address - Country:US
Practice Address - Phone:949-824-5515
Practice Address - Fax:949-824-7454
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC500740207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C500740Medicaid
CAA96575Medicare UPIN
CAWC50074AMedicare ID - Type Unspecified