Provider Demographics
NPI:1215963392
Name:ZUCKER, DAVID S (MD, PHD, FAAPMR)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:ZUCKER
Suffix:
Gender:M
Credentials:MD, PHD, FAAPMR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:1600 E JEFFERSON ST STE 300
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5645
Practice Address - Country:US
Practice Address - Phone:206-215-6333
Practice Address - Fax:206-386-2999
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031686208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1121730Medicaid
WAG8867663Medicare PIN
WA1121730Medicaid
WAF45076Medicare UPIN