Provider Demographics
NPI:1669480802
Name:ZAPATA, CARLOS ALFREDO (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ALFREDO
Last Name:ZAPATA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CARLOS
Other - Middle Name:ALFREDO
Other - Last Name:ZAPATA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2173 CENTERVILLE PL STE B
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-8303
Mailing Address - Country:US
Mailing Address - Phone:850-878-2113
Mailing Address - Fax:850-878-2839
Practice Address - Street 1:2173 CENTERVILLE PL STE B
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-8303
Practice Address - Country:US
Practice Address - Phone:850-878-2113
Practice Address - Fax:850-878-2839
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME37183174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039817900Medicaid
FL37402Medicare ID - Type Unspecified
FL039817900Medicaid