1386729580 NPI number — DARRELL J ZEHR D.M.D.

Table of content: DARRELL J ZEHR D.M.D. (NPI 1386729580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386729580 NPI number — DARRELL J ZEHR D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZEHR
Provider First Name:
DARRELL
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386729580
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2710 DAVIS STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERIDIAN
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39301-5708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-693-0118
Provider Business Mailing Address Fax Number:
601-553-8175

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 BIRCH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEKALB
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-693-0118
Provider Business Practice Location Address Fax Number:
601-553-8175
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  5348 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 3318-07 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00660271 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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