Provider Demographics
NPI:1902624257
Name:ZAKARIYA, PATRON NDAYAMBAJE
Entity type:Individual
Prefix:
First Name:PATRON
Middle Name:NDAYAMBAJE
Last Name:ZAKARIYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5007 CHARITON DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-2993
Mailing Address - Country:US
Mailing Address - Phone:616-323-4808
Mailing Address - Fax:
Practice Address - Street 1:5007 CHARITON DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-2993
Practice Address - Country:US
Practice Address - Phone:616-323-4808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOD211311004172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver