MEDICARE: DR. ZACHARY CLARK BAYER PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TR0400X	Rehabilitation Psychologist	PSY003849	GA
2	103G00000X	Clinical Neuropsychologist	9214	FL

General Provider Information

NPI Number	:	1619296555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZACHARY CLARK BAYER PSYD

Provider Business Mailing Address
First Line	:	3 VINE AVE NE
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32548-5069
Country	:	US
Telephone Number	:	850-226-7666
Fax Number	:	850-226-7499

Provider Business Practice Location Address
First Line	:	3 VINE AVE NE
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32548-5069
Country	:	US
Telephone Number	:	850-226-7666
Fax Number	:	850-226-7499

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2010
Last Update Date	:	08/19/2016

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