Provider Demographics
NPI:1184761033
Name:ZIEVERS, PAUL C (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:C
Last Name:ZIEVERS
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 1:1277 WOODWARD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:TOUCHET
Mailing Address - State:WA
Mailing Address - Zip Code:99360-9709
Mailing Address - Country:US
Mailing Address - Phone:509-529-1284
Mailing Address - Fax:509-522-1798
Practice Address - Street 1:401 W POPLAR ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2846
Practice Address - Country:US
Practice Address - Phone:509-529-1284
Practice Address - Fax:509-522-1798
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020237207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8458408Medicaid
A06645Medicare UPIN
WA8458408Medicaid