Provider Demographics
NPI:1366472383
Name:BANSAGI, ZSOLT C (MD)
Entity Type:Individual
Prefix:DR
First Name:ZSOLT
Middle Name:C
Last Name:BANSAGI
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 1:2800 ROSS CLARK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301
Mailing Address - Country:US
Mailing Address - Phone:334-793-2211
Mailing Address - Fax:334-793-7161
Practice Address - Street 1:210 FOREST PARK CIRCLE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405
Practice Address - Country:US
Practice Address - Phone:850-763-9550
Practice Address - Fax:334-793-7161
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89726207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051556560Medicare ID - Type Unspecified
I11140Medicare UPIN
FL48112ZMedicare ID - Type Unspecified