Provider Demographics
NPI:1265532097
Name:ZIEBARTH, DAVID MATTHEW (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MATTHEW
Last Name:ZIEBARTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8965 RIVER SOUND DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-0638
Mailing Address - Country:US
Mailing Address - Phone:901-751-3147
Mailing Address - Fax:901-754-4838
Practice Address - Street 1:1172 VICKERY LN
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-1619
Practice Address - Country:US
Practice Address - Phone:901-757-0095
Practice Address - Fax:901-754-4838
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23612208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNA40672Medicare UPIN