Provider Demographics
NPI:1346221306
Name:ZEMA, ROGER L (DPM)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:L
Last Name:ZEMA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5535 S WILLIAMSON BLVD
Mailing Address - Street 2:STE 727
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-8312
Mailing Address - Country:US
Mailing Address - Phone:904-501-7635
Mailing Address - Fax:386-333-6456
Practice Address - Street 1:6487 JUSTIN CT
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-7339
Practice Address - Country:US
Practice Address - Phone:904-501-7635
Practice Address - Fax:386-333-6456
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPO3320213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65979OtherBCBS
FL340676800Medicaid