Provider Demographics
NPI:1457380438
Name:ZWIACHER, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ZWIACHER
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 1:3640 N TRAVELAIR DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-4312
Mailing Address - Country:US
Mailing Address - Phone:907-357-4951
Mailing Address - Fax:
Practice Address - Street 1:2490 S WOODWORTH LOOP
Practice Address - Street 2:SUITE 300
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-7405
Practice Address - Country:US
Practice Address - Phone:907-357-1917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3719208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK160762Medicare PIN