=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467789727
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHANNE A ZEPHIR D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2009
-----------------------------------------------------
Last Update Date | 06/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 810 W MOWRY DR
-----------------------------------------------------
City | HOMESTEAD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33030-5746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-253-5100
-----------------------------------------------------
Fax | 305-254-4967
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10300 SW 216TH ST
-----------------------------------------------------
City | CUTLER BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33190-1003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-253-5100
-----------------------------------------------------
Fax | 305-247-7536
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OS11818
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------