Provider Demographics
NPI:1619296555
Name:BAYER, ZACHARY CLARK (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:CLARK
Last Name:BAYER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 VINE AVE NE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5069
Mailing Address - Country:US
Mailing Address - Phone:850-226-7666
Mailing Address - Fax:850-226-7499
Practice Address - Street 1:3 VINE AVE NE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5069
Practice Address - Country:US
Practice Address - Phone:850-226-7666
Practice Address - Fax:850-226-7499
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003849103TR0400X
FL9214103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation