Healthcare Provider Details

I. General information

NPI: 1770902249
Provider Name (Legal Business Name): ZACHARY MCVICKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 GREENWOOD AVE STE 203
WEST PALM BEACH FL
33407-2452
US

IV. Provider business mailing address

2055 MILITARY TRL STE 204
JUPITER FL
33458-7830
US

V. Phone/Fax

Practice location:
  • Phone: 561-844-5255
  • Fax: 561-844-5245
Mailing address:
  • Phone: 561-277-3807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA160870
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberME145638
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: