Provider Demographics
NPI:1689659781
Name:ZAX, ROBERT HENRY (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:HENRY
Last Name:ZAX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:444 S 1ST ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1474
Mailing Address - Country:US
Mailing Address - Phone:502-814-1972
Mailing Address - Fax:502-585-4824
Practice Address - Street 1:2307 RIVER RD STE 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-5000
Practice Address - Country:US
Practice Address - Phone:502-583-6647
Practice Address - Fax:502-585-4824
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY25359207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100347220Medicaid
KY64253594Medicaid
KYP00003505OtherRR MCR PALMETTO
IN100347220Medicaid
KY0754902Medicare PIN