Healthcare Provider Details

I. General information

NPI: 1104302991
Provider Name (Legal Business Name): WAGIH ZAYED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2018
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3001
US

IV. Provider business mailing address

PO BOX 100224
GAINESVILLE FL
32610-0224
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-9180
  • Fax:
Mailing address:
  • Phone: 352-273-9180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME182389
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME182389
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2021024881
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: