Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 328827-1205 | UT |
NPI | 1003808940 |
---|---|
Provider Name | James S Zebrack |
First Address | Atlanta, GA 30374-1729 |
Second Address | Salt Lake City, UT 84124-1202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2005 |
Last Update Date | 27/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D2130 | (05) | UT |