Provider Demographics
NPI:1336371517
Name:ZINSER, DERYK MARK (DO)
Entity Type:Individual
Prefix:
First Name:DERYK
Middle Name:MARK
Last Name:ZINSER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36860 INDUSTRIAL WAY
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-7371
Mailing Address - Country:US
Mailing Address - Phone:503-826-0206
Mailing Address - Fax:503-826-0216
Practice Address - Street 1:36860 INDUSTRIAL WAY
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-7371
Practice Address - Country:US
Practice Address - Phone:503-826-0206
Practice Address - Fax:503-826-0216
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO156518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine