Healthcare Provider Details

I. General information

NPI: 1720068315
Provider Name (Legal Business Name): STEPHEN ANTHONY ZILLER III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8333 N DAVIS HWY
PENSACOLA FL
32514-6050
US

IV. Provider business mailing address

8333 N DAVIS HWY
PENSACOLA FL
32514-6050
US

V. Phone/Fax

Practice location:
  • Phone: 850-474-8428
  • Fax: 850-969-2906
Mailing address:
  • Phone: 850-474-8428
  • Fax: 850-969-2906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberN7800
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME132426
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: