Healthcare Provider Details

I. General information

NPI: 1629342829
Provider Name (Legal Business Name): JOSHUA S.ZAGER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 JUPITER LAKES BLVD BLDG 4000 SUITE 202
JUPITER FL
33458-7191
US

IV. Provider business mailing address

2800 S SEACREST BLVD SUITE 100
BOYNTON BEACH FL
33435-7960
US

V. Phone/Fax

Practice location:
  • Phone: 561-327-4573
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO 3040
License Number StateFL

VIII. Authorized Official

Name: JOSHUA ZAGER
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 561-704-0797