Provider Demographics
NPI:1124063102
Name:ZACHER, JUDY L (MD)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:L
Last Name:ZACHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3974 NEW VISION DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1712
Mailing Address - Country:US
Mailing Address - Phone:260-471-5980
Mailing Address - Fax:260-471-5981
Practice Address - Street 1:3974 NEW VISION DRIVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1712
Practice Address - Country:US
Practice Address - Phone:260-471-5980
Practice Address - Fax:260-471-5981
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054348A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000381394OtherANTHEM PIN NUMBER
IN1919896OtherFIRST HEALTH/COVENTRY
IN1919896OtherFIRST HEALTH/COVENTRY
INH48814Medicare UPIN