Provider Demographics
NPI:1144234691
Name:ZAYAS, EGBERTO JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:EGBERTO
Middle Name:JOSE
Last Name: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 102222
Mailing Address - Street 2:CREDENTIAL DEPARTMENT
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-432-8339
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:3000 MEDICAL PARK DR STE 25
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4680
Practice Address - Country:US
Practice Address - Phone:813-632-6220
Practice Address - Fax:813-971-5893
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65260207R00000X, 207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0065260OtherFLORIDA LICENSE
FL374050100Medicaid
FLC77613Medicare UPIN
FLME0065260OtherFLORIDA LICENSE
FL23617AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER