Provider Demographics
NPI:1093769614
Name:BROYER, ZACH (MD)
Entity Type:Individual
Prefix:
First Name:ZACH
Middle Name:
Last Name:BROYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21110 BISCAYNE BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1251
Mailing Address - Country:US
Mailing Address - Phone:954-458-1199
Mailing Address - Fax:954-458-1833
Practice Address - Street 1:21110 BISCAYNE BLVD STE 205
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1251
Practice Address - Country:US
Practice Address - Phone:954-458-1199
Practice Address - Fax:954-458-1833
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA80275002081P2900X
PAMD074300L2081P2900X
PAMD-074300-L2081P2900X
FLME1464382081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2074348000OtherIBC
PA2886235OtherAETNA
5005060OtherCIGNA
PA2886235OtherAETNA
PA250014135Medicare PIN
PA057331GC6Medicare PIN