Individual
SAMUEL L. ZUCKERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
MOUNTAIN NEONATOLOGY LLC, 3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(602) 346-7013
Mailing address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(210) 737-4928
Taxonomy
Speciality
Code
Description
License number
State
207LP3000X
Pediatric Anesthesiology Physician
J9854
TX
2080P0203X
Pediatric Critical Care Medicine Physician
J9854
TX
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
M-15488
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
132776910
—
TX
05
—
132776911
—
TX
05
—
132776912
—
TX
05
—
200102900 A
—
OH
05
—
33787336
—
NM
Enumeration date
04/27/2006
Last updated
12/10/2020
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