Individual
ZACKERY J TEGGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MCMS, PA-C
Contact information
Practice address
4007 ESTATE DIAMOND RUBY, CHRISTIANSTED, VI 00820
(340) 778-6311
Mailing address
1035 KEPLER DR, GREEN BAY, WI 54311-8320
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4320
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100077680
—
WI
Enumeration date
03/31/2017
Last updated
04/07/2022
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