Provider Demographics
NPI:1972323087
Name:MOELLER, ZACHARY JOSEPH (PA-C)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:JOSEPH
Last Name:MOELLER
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 1:16282 41ST ST
Mailing Address - Street 2:
Mailing Address - City:BECKER
Mailing Address - State:MN
Mailing Address - Zip Code:55308-8532
Mailing Address - Country:US
Mailing Address - Phone:320-249-8154
Mailing Address - Fax:
Practice Address - Street 1:12800 ROLLING RIDGE RD
Practice Address - Street 2:
Practice Address - City:BECKER
Practice Address - State:MN
Practice Address - Zip Code:55308-8838
Practice Address - Country:US
Practice Address - Phone:763-261-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN15138207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine