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General NPI Number Information
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NPI Number | 1942763941
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Entity Type | Individual
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Provider Name | ZACKARY BRYCE WHITNEY DO
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Gender | Male
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Dates
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Enumeration Date | 04/08/2019
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Last Update Date | 07/06/2021
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Provider Practice Location Address
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Address Line | 409 SUMMIT RIDGE PL APT 107
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City | LONGWOOD
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State | FL
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Zip | 32779-6251
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Country | US
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Telephone | 435-215-6012
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Fax |
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Provider Business Mailing Address
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Address Line | 409 SUMMIT RIDGE PL APT 107
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City | LONGWOOD
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State | FL
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Zip | 32779-6251
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Country | US
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Telephone | 435-215-6012
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 6696
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | OS17969
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License Number State | FL
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