Healthcare Provider Details

I. General information

NPI: 1932101524
Provider Name (Legal Business Name): JOHN ZAPP III
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 KINGSLEY AVE
ORANGE PARK FL
32073-5148
US

IV. Provider business mailing address

PO BOX 861774
ORLANDO FL
32886-1774
US

V. Phone/Fax

Practice location:
  • Phone: 904-421-2119
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME70443
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: