Provider Demographics
NPI:1508807488
Name:JOHN ZAK III PA INC
Entity Type:Organization
Organization Name:JOHN ZAK III PA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAK
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:386-255-4425
Mailing Address - Street 1:570 MEMORIAL CIR STE 110
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5063
Mailing Address - Country:US
Mailing Address - Phone:386-437-5980
Mailing Address - Fax:386-437-5981
Practice Address - Street 1:570 MEMORIAL CIR STE 110
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5063
Practice Address - Country:US
Practice Address - Phone:386-437-5980
Practice Address - Fax:386-437-5981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372114100Medicaid
FL14911Medicare ID - Type Unspecified
FLF24881Medicare UPIN