Provider Demographics
NPI:1215466230
Name:WAKERLIG, ZACKARY WALKER (LXMO)
Entity type:Individual
Prefix:
First Name:ZACKARY
Middle Name:WALKER
Last Name:WAKERLIG
Suffix:
Gender:M
Credentials:LXMO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 W ELM AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-2713
Mailing Address - Country:US
Mailing Address - Phone:541-567-2995
Mailing Address - Fax:541-567-7720
Practice Address - Street 1:1050 W ELM AVE STE 110
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-2713
Practice Address - Country:US
Practice Address - Phone:541-567-2995
Practice Address - Fax:541-567-7720
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9161542471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography