Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 01073675A | IN |
N | 208600000X | Surgeon | 01073675A | IN |
N | 208200000X | Surgeon | 70988 | WI |
N | 208600000X | Surgeon | 70988 | WI |
N | 2086S0102X | Surgical Critical Care | 01073675A | IN |
N | 2086S0127X | Trauma Surgeon | 31943 | TN |
Y | 2086S0127X | Trauma Surgeon | 70988 | WI |
NPI | 1396795704 |
---|---|
Provider Name | Ben Louis Zarzaur JR. |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792-1212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 13/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201219990 | (05) | IN |
I05896 | (02) |