Healthcare Provider Details

I. General information

NPI: 1174704001
Provider Name (Legal Business Name): RALPH J ZWOLINSKI M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3951 S NOVA RD
PORT ORANGE FL
32127-9270
US

IV. Provider business mailing address

3951 S NOVA RD
PORT ORANGE FL
32127-9270
US

V. Phone/Fax

Practice location:
  • Phone: 386-763-4484
  • Fax:
Mailing address:
  • Phone: 386-763-4484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: RALPH J ZWOLINSKI
Title or Position: DIRECTOR/OWNER
Credential: MD
Phone: 386-763-4484