Basic Information
Provider Information
NPI: 1033558259
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZARKADIS
FirstName: NICHOLAS
MiddleName: J
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5005 N PIEDRAS ST
Address2: GRADUATE MEDICAL EDUCATION
City: EL PASO
State: TX
PostalCode: 799205001
CountryCode: US
TelephoneNumber: 9157422521
FaxNumber: 9157422653
Practice Location
Address1: 5005 N PIEDRAS ST
Address2: GRADUATE MEDICAL EDUCATION
City: EL PASO
State: TX
PostalCode: 799205001
CountryCode: US
TelephoneNumber: 9157422521
FaxNumber: 9157422653
Other Information
ProviderEnumerationDate: 06/20/2013
LastUpdateDate: 06/20/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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