Individual
ZACK JOSEPH DALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-1164
(503) 494-5502
Mailing address
PO BOX 936857, ATLANTA, GA 31193-6857
(910) 667-2606
(910) 815-5698
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD18220
RI
207R00000X
Internal Medicine Physician
MD193568
OR
208M00000X
Hospitalist Physician
Primary
2025-03676
NC
208M00000X
Hospitalist Physician
MD193568
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD18220
RHODE ISLAND STATE MEDICAL LICENSE
RI
Enumeration date
03/20/2018
Last updated
01/28/2026
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