Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 11816 | NV |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 11816 | NV |
NPI | 1376591735 |
---|---|
Provider Name | John Eric Zebrack |
First Address | Reno, NV 89503-4724 |
Second Address | Reno, NV 89503-4724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 22/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11614044 | CAQH (01) | |
C96723 | (02) | NV |