Basic Information
| Provider Information | |||||||||
| NPI: | 1003442138 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JARRETT | ||||||||
| FirstName: | ZACH | ||||||||
| MiddleName: | |||||||||
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| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JARRETT | ||||||||
| OtherFirstName: | ZACHARY | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | DO | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | SAN ANTONIO MILITARY MEDICAL CENTER, MCHE-ZDM-M | ||||||||
| Address2: | 3551 ROGER BROOKE DR | ||||||||
| City: | JBSA FORT SAM HOUSTON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 782344504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109165910 | ||||||||
| FaxNumber: | 2109162077 | ||||||||
| Practice Location | |||||||||
| Address1: | SAN ANTONIO MILITARY MEDICAL CENTER, MCHE-ZDM-M | ||||||||
| Address2: | 3551 ROGER BROOKE DR | ||||||||
| City: | JBSA FORT SAM HOUSTON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 782344504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109165910 | ||||||||
| FaxNumber: | 2109162077 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2020 | ||||||||
| LastUpdateDate: | 01/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 0103442138 | VA | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.