Healthcare Provider Details

I. General information

NPI: 1487002184
Provider Name (Legal Business Name): ZACHARY PAUL HERZWURM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13020 N TELECOM PKWY
TEMPLE TERRACE FL
33637-0915
US

IV. Provider business mailing address

811 13TH ST STE 20
AUGUSTA GA
30901-2771
US

V. Phone/Fax

Practice location:
  • Phone: 813-978-9700
  • Fax:
Mailing address:
  • Phone: 706-722-3401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME154088
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number85347
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number85347
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: