Basic Information
| Provider Information | |||||||||
| NPI: | 1295767077 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZARA | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ZARA | ||||||||
| OtherFirstName: | JOSH | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 801 SAINT MARYS DR STE 205W | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477140556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124776103 | ||||||||
| FaxNumber: | 8124774897 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 SAINT MARYS DR STE 205W | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124776103 | ||||||||
| FaxNumber: | 8124774897 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 10/17/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 01079661A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | 36912 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | 35.095854 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | 28666 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | J1820 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 129893706 | 05 | TX | MEDICAID | 8F0715 | 01 | TX | BCBS | OTHER | P01660042 | 01 | OH | RAILROAD MEDICARE - MHCPI | OTHER | 0141842 | 05 | OH | MEDICAID | 3810029688 | 05 | WV | MEDICAID | 294218 | 05 | AZ | MEDICAID | 1288142 | 01 | AZ | CIGNA | OTHER | 4331326 | 01 | AZ | AETNA | OTHER |