Basic Information
| Provider Information | |||||||||
| NPI: | 1992931711 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FISK | ||||||||
| FirstName: | ZACHARY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1310 116TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980043817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254403351 | ||||||||
| FaxNumber: | 4254403439 | ||||||||
| Practice Location | |||||||||
| Address1: | 1310 116TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980043817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254403351 | ||||||||
| FaxNumber: | 4254403439 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2009 | ||||||||
| LastUpdateDate: | 12/08/2016 | ||||||||
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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 | 390200000X | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207L00000X | 60491842 | WA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0000X | MD60491842 | WA | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.