Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | PTH 3301 | AL |
NPI | 1033101365 |
---|---|
Provider Name | Mr. Mark W Zahara |
First Address | Birmingham, AL 35233-1111 |
Second Address | Birmingham, AL 35233-1111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
51505107 | BLUE CROSS (01) | AL |
PTH 3301 | (02) | AL |