Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | G7610 | TX |
Y | 207Q00000X | Family Doctor | MD2015-0091 | NM |
N | 207QS0010X | Family Doctor - Sports Medicine | G7610 | TX |
NPI | 1295796480 |
---|---|
Provider Name | Dr. Vance Edward Zachary |
First Address | Albuquerque, NM 87114-5915 |
Second Address | Albuquerque, NM 87114-5915 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2006 |
Last Update Date | 05/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25156772 | (05) | NM |
401311YR41 | MEDICARE NUMBER (01) | NM |