Provider Demographics
NPI:1740240571
Name:ZODY, BILLIE (MD)
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:
Last Name:ZODY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3067 TAMIAMI TRL STE 1
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6619
Mailing Address - Country:US
Mailing Address - Phone:941-766-0400
Mailing Address - Fax:
Practice Address - Street 1:3067 TAMIAMI TRL STE 1
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6619
Practice Address - Country:US
Practice Address - Phone:941-766-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01065763A207V00000X
FLME151539207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201043410Medicaid
IN201043410Medicaid
AZ797483Medicare ID - Type UnspecifiedAHCCCS NUMBER