Healthcare Provider Details

I. General information

NPI: 1679936413
Provider Name (Legal Business Name): ADRIAN CARLOS ZAMORA III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15420 COLLIER BLVD
NAPLES FL
34120-3917
US

IV. Provider business mailing address

2271 GROVE DR
NAPLES FL
34120-7497
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-0600
  • Fax:
Mailing address:
  • Phone: 708-623-4992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125-069445
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME142525
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: