Basic Information
| Provider Information | |||||||||
| NPI: | 1235394891 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOOMSAAD | ||||||||
| FirstName: | ZACKARY | ||||||||
| MiddleName: | ELIAS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20280 N 59TH AVE STE 115-317 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853086850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704737900 | ||||||||
| FaxNumber: | 9704737901 | ||||||||
| Practice Location | |||||||||
| Address1: | 7251 W 20TH ST UNIT K | ||||||||
| Address2: | |||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806344626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027958700 | ||||||||
| FaxNumber: | 6027958701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2008 | ||||||||
| LastUpdateDate: | 06/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | ME133521 | FL | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 208VP0014X | DR.0066118 | CO | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.