Healthcare Provider Details

I. General information

NPI: 1942872387
Provider Name (Legal Business Name): MATTHEW JAMES ZOGHT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 MEMORIAL MEDICAL PKWY STE 2806
PALM COAST FL
32164-5999
US

IV. Provider business mailing address

61 MEMORIAL MEDICAL PKWY STE 2806
PALM COAST FL
32164-5999
US

V. Phone/Fax

Practice location:
  • Phone: 386-586-1920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME167545
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: