Provider Demographics
NPI:1538143854
Name:ZAFAR, DARYOUSH A (DPM)
Entity Type:Individual
Prefix:
First Name:DARYOUSH
Middle Name:A
Last Name:ZAFAR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8851 BOARDROOM CIRCLE
Mailing Address - Street 2:
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4888
Mailing Address - Country:US
Mailing Address - Phone:239-481-7000
Mailing Address - Fax:239-481-8150
Practice Address - Street 1:9250 CORKSCREW RD
Practice Address - Street 2:SUITE 7
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-3208
Practice Address - Country:US
Practice Address - Phone:239-481-7000
Practice Address - Fax:239-481-8150
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2799213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5079250001OtherMEDICARE DME
FLP00146311OtherRAILROAD MEDICARE
FLP00146311OtherRAILROAD MEDICARE
476428Medicare UPIN
FLE29108Medicare ID - Type Unspecified