Healthcare Provider Details

I. General information

NPI: 1598730103
Provider Name (Legal Business Name): STANLEY MARTIN ZUBA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2006
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91550 OVERSEAS HWY SUITE #209
TAVERNIER FL
33070-2506
US

IV. Provider business mailing address

91550 OVERSEAS HWY 209
TAVERNIER FL
33070-2506
US

V. Phone/Fax

Practice location:
  • Phone: 305-853-0558
  • Fax: 305-853-0744
Mailing address:
  • Phone: 305-853-0558
  • Fax: 305-853-0744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME72754
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: