=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982140729
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ISAAC ZAMORA MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2017
-----------------------------------------------------
Last Update Date | 01/18/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1219 S EAST AVE #310
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34239-2340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-365-0330
-----------------------------------------------------
Fax | 941-951-7508
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1219 S EAST AVE #310
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34239-2340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-365-0330
-----------------------------------------------------
Fax | 941-951-7508
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | ISAAC ZAMORA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 941-365-0330
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME38300
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------