Provider Demographics
NPI:1801979182
Name:ZEGARRA, HERNAN MARIO (MD)
Entity type:Individual
Prefix:DR
First Name:HERNAN
Middle Name:MARIO
Last Name:ZEGARRA
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 1:2808 N C ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-2722
Mailing Address - Country:US
Mailing Address - Phone:620-937-8900
Mailing Address - Fax:620-272-0479
Practice Address - Street 1:2808 N C ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-2722
Practice Address - Country:US
Practice Address - Phone:620-937-8900
Practice Address - Fax:620-272-0479
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-23654208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSF31949Medicare UPIN