Provider Demographics
NPI:1447489893
Name:REAGLE, G. ZACHARIA (DO)
Entity type:Individual
Prefix:DR
First Name:G. ZACHARIA
Middle Name:
Last Name:REAGLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:GABRIEL
Other - Middle Name:ZACHARIA
Other - Last Name:REAGLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 7446
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-0446
Mailing Address - Country:US
Mailing Address - Phone:970-663-2742
Mailing Address - Fax:970-667-0847
Practice Address - Street 1:1400 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5906
Practice Address - Country:US
Practice Address - Phone:805-739-3000
Practice Address - Fax:970-667-0847
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10912207R00000X, 207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A10912OtherLICENSE #
CA20A10912OtherLICENSE #