Provider Demographics
NPI:1932729290
Name:BEAVERS, ZACHARY (MD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:
Last Name:BEAVERS
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 1:3051 KIESEL RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2449
Mailing Address - Country:US
Mailing Address - Phone:989-439-0128
Mailing Address - Fax:
Practice Address - Street 1:3051 KIESEL RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2449
Practice Address - Country:US
Practice Address - Phone:989-778-2888
Practice Address - Fax:989-778-2887
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-16
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351046131207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty