Provider Demographics
NPI:1114948346
Name:DE ZAYAS, LUIS E (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:E
Last Name:DE ZAYAS
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:PO BOX 560605
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32956-0605
Mailing Address - Country:US
Mailing Address - Phone:321-632-0012
Mailing Address - Fax:321-632-8532
Practice Address - Street 1:1282 US HIGHWAY 1
Practice Address - Street 2:SUITE 2
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2747
Practice Address - Country:US
Practice Address - Phone:321-632-0012
Practice Address - Fax:321-632-8532
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51039207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09816XMedicare ID - Type Unspecified
FLB14925Medicare UPIN