Provider Demographics
NPI:1629467741
Name:AXELROD, DAVID ZUCKERMAN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ZUCKERMAN
Last Name:AXELROD
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 1:3740 S OCEAN BLVD
Mailing Address - Street 2:APT 603
Mailing Address - City:HIGHLAND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33487-3400
Mailing Address - Country:US
Mailing Address - Phone:561-279-9371
Mailing Address - Fax:
Practice Address - Street 1:3740 S OCEAN BLVD
Practice Address - Street 2:APT 603
Practice Address - City:HIGHLAND BEACH
Practice Address - State:FL
Practice Address - Zip Code:33487-3400
Practice Address - Country:US
Practice Address - Phone:561-279-9371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101027274174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist