Provider Demographics
NPI:1124067707
Name:ZEYFANG, DAVID W (PA-C)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:W
Last Name:ZEYFANG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 NEW ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-3654
Mailing Address - Country:US
Mailing Address - Phone:339-379-9708
Mailing Address - Fax:336-553-2085
Practice Address - Street 1:309 NEW ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-3654
Practice Address - Country:US
Practice Address - Phone:339-379-9708
Practice Address - Fax:336-553-2085
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100919363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC561274347OtherCKA'S TAX ID#
NC8102885Medicaid
NC561274347OtherCKA'S TAX ID#
NCP36686Medicare UPIN