Healthcare Provider Details

I. General information

NPI: 1467961300
Provider Name (Legal Business Name): MICHAEL ALLAN ZAFFT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 11/01/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 BOATNER RD STE 114
EGLIN AFB FL
32542-1302
US

IV. Provider business mailing address

307 BOATNER RD STE 114
EGLIN AFB FL
32542
US

V. Phone/Fax

Practice location:
  • Phone: 850-883-8272
  • Fax:
Mailing address:
  • Phone: 850-883-8272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2146
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: