Provider Demographics
NPI:1396094108
Name:ZAHARAS, PHILIP N (PA)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:N
Last Name:ZAHARAS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 CENTENNIAL HILLS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-3265
Mailing Address - Country:US
Mailing Address - Phone:307-265-7205
Mailing Address - Fax:307-235-6262
Practice Address - Street 1:4140 CENTENNIAL HILLS BLVD STE A
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-3265
Practice Address - Country:US
Practice Address - Phone:307-265-7205
Practice Address - Fax:307-235-6262
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
WY554363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical