Provider Demographics
NPI:1649841248
Name:CETRARO, ZACHARY ADAM (DO)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:ADAM
Last Name:CETRARO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:ZACHARY
Other - Middle Name:CETRARO
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:527 GOTT RD BLDG 810
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73705-5103
Mailing Address - Country:US
Mailing Address - Phone:580-213-7416
Mailing Address - Fax:
Practice Address - Street 1:527 GOTT RD BLDG 810
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73705-5103
Practice Address - Country:US
Practice Address - Phone:580-213-7416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-05
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS19777207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine