Provider Demographics
NPI:1912946377
Name:FLAKE, ZACHARY A (MD)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:A
Last Name:FLAKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2901 N CENTRAL AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2702
Mailing Address - Country:US
Mailing Address - Phone:970-820-5000
Mailing Address - Fax:970-820-5061
Practice Address - Street 1:2923 GINNALA DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2702
Practice Address - Country:US
Practice Address - Phone:970-820-5000
Practice Address - Fax:970-203-1029
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0431195207Q00000X
CO42082207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO96401222Medicaid
CO96401222Medicaid
COC811301Medicare PIN
COP00620869Medicare PIN