Individual
ZACCARIAH DESMOND IVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
13123 E 16TH AVE, AURORA, CO 80045-7106
(720) 777-1234
Mailing address
PO BOX 110429, AURORA, CO 80042-0429
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA.0003256
CO
363AM0700X
Medical Physician Assistant
Primary
PA.0003256
CO
Other
Enumeration date
08/10/2011
Last updated
08/04/2025
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