Basic Information
Provider Information
NPI: 1003000704
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GATTON
FirstName: ZACHARY
MiddleName: MARK
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1330 COSHOCTON AVE
Address2:  
City: MOUNT VERNON
State: OH
PostalCode: 430501440
CountryCode: US
TelephoneNumber: 7403939000
FaxNumber:  
Practice Location
Address1: 1330 COSHOCTON AVE
Address2:  
City: MOUNT VERNON
State: OH
PostalCode: 430501440
CountryCode: US
TelephoneNumber: 7403936585
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/05/2007
LastUpdateDate: 09/16/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X35097335OHY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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