Provider Demographics
NPI:1528009339
Name:ZAGVAZDINA, IA B (MD)
Entity Type:Individual
Prefix:
First Name:IA
Middle Name:B
Last Name:ZAGVAZDINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 S STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33023-6718
Mailing Address - Country:US
Mailing Address - Phone:954-743-5522
Mailing Address - Fax:954-743-5632
Practice Address - Street 1:390 S STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33023-6718
Practice Address - Country:US
Practice Address - Phone:954-743-5522
Practice Address - Fax:954-743-5632
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82035207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
71334OtherFLORIDA BLUE
71334OtherFLORIDA BLUE
71334ZMedicare ID - Type Unspecified