Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | DR.0065909 | CO |
NPI | 1023538956 |
---|---|
Provider Name | Zachary Ingersoll |
First Address | South Miami, FL 33143-4701 |
Second Address | Grand Junction, CO 81501-8858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2017 |
Last Update Date | 16/02/2021 |