Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | MD11889 | OR |
NPI | 1114928058 |
---|---|
Provider Name | Arlan George Zastrow |
First Address | Roseburg, OR 97471-1645 |
Second Address | Roseburg, OR 97471-1645 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 18/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
217539 | (05) | OR |
C94145 | (02) | OR |