Healthcare Provider Details

I. General information

NPI: 1740240571
Provider Name (Legal Business Name): BILLIE ZODY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3067 TAMIAMI TRL STE 1
PORT CHARLOTTE FL
33952-6619
US

IV. Provider business mailing address

3067 TAMIAMI TRL STE 1
PORT CHARLOTTE FL
33952-6619
US

V. Phone/Fax

Practice location:
  • Phone: 941-766-0400
  • Fax:
Mailing address:
  • Phone: 941-766-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01065763A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberME151539
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: