Provider Demographics
NPI:1427082692
Name:ZLOCK, DOUGLAS W (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:W
Last Name:ZLOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:DEPT 34929
Mailing Address - Street 2:P.O. BOX 39000
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94139-0001
Mailing Address - Country:US
Mailing Address - Phone:925-952-2828
Mailing Address - Fax:925-952-2850
Practice Address - Street 1:1450 TREAT BLVD
Practice Address - Street 2:SUITE 250A
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-2168
Practice Address - Country:US
Practice Address - Phone:925-296-9740
Practice Address - Fax:925-296-9062
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG68305207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G683050Medicaid
CA00G683050Medicare PIN
CA00G683050Medicaid
CA110133888Medicare PIN