Provider Demographics
NPI:1861418923
Name:ZACHARIAH, PHEBA (DO)
Entity type:Individual
Prefix:
First Name:PHEBA
Middle Name:
Last Name:ZACHARIAH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7105 FM 2920 RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-2210
Mailing Address - Country:US
Mailing Address - Phone:281-737-1162
Mailing Address - Fax:281-737-1163
Practice Address - Street 1:7105 FM 2920 RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-2210
Practice Address - Country:US
Practice Address - Phone:281-737-1162
Practice Address - Fax:281-737-1163
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-112510207Q00000X
MO2010035689207Q00000X
TXP8328207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8EG589OtherBCBS
TX342778301Medicaid
TX342778302Medicaid
IL036112510Medicaid
TX8FT385OtherBCBS
TX8FT385OtherBCBS
TX342778302Medicaid
I37952Medicare UPIN