Provider Demographics
NPI:1598730103
Name:ZUBA, STANLEY MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:MARTIN
Last Name:ZUBA
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 1:91550 OVERSEAS HWY
Mailing Address - Street 2:209
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070-2506
Mailing Address - Country:US
Mailing Address - Phone:305-853-0558
Mailing Address - Fax:305-853-0744
Practice Address - Street 1:91550 OVERSEAS HWY
Practice Address - Street 2:SUITE #209
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2506
Practice Address - Country:US
Practice Address - Phone:305-853-0558
Practice Address - Fax:305-853-0744
Is Sole Proprietor?:No
Enumeration Date:2006-02-18
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72754208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252832100Medicaid
FL252832100Medicaid
42375Medicare ID - Type Unspecified