Healthcare Provider Details

I. General information

NPI: 1740208636
Provider Name (Legal Business Name): JULIO ZAVALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 9TH AVE N
ST PETERSBURG FL
33713-6832
US

IV. Provider business mailing address

5340 CREEKSIDE TRL
SARASOTA FL
34243-3878
US

V. Phone/Fax

Practice location:
  • Phone: 727-328-6185
  • Fax: 727-328-6187
Mailing address:
  • Phone: 941-351-0777
  • Fax: 727-507-3618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME0048099
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: