Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 2901021133 | MI |
N | 1223G0001X | General Practice | 9289 | KY |
N | 213EG0000X | General Practice | 9289 | KY |
NPI | 1730525569 |
---|---|
Provider Name | Dr. Zachary Adrian Brian |
First Address | Saint Ignace, MI 49781-1048 |
Second Address | Saint Ignace, MI 49781 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2013 |
Last Update Date | 04/04/2014 |