Individual
ZACHARY ANDREW WULBECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9200 UNIVERSITY BLVD, NORTH CHARLESTON, SC 29406-9121
(438) 637-4628
Mailing address
PO BOX 118087, NORTH CHARLESTON, SC 29423-8087
(843) 863-7462
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3497
SC
363A00000X
Physician Assistant
PA.0003686
CO
363AM0700X
Medical Physician Assistant
1580
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
25779231
—
CO
01
—
P01212979
RAILROAD MEDICARE PIN
CO
Enumeration date
02/14/2011
Last updated
08/31/2020
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