Healthcare Provider Details

I. General information

NPI: 1164431037
Provider Name (Legal Business Name): PAUL D. ZAWATSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11481 OLD SAINT AUGUSTINE RD STE 103
JACKSONVILLE FL
32258-1474
US

IV. Provider business mailing address

11481 OLD SAINT AUGUSTINE RD STE 103
JACKSONVILLE FL
32258-1474
US

V. Phone/Fax

Practice location:
  • Phone: 904-260-8424
  • Fax: 904-341-4777
Mailing address:
  • Phone: 904-260-8424
  • Fax: 904-341-4777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME63004
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME63004
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: