Provider Demographics
NPI:1750508446
Name:ZAMBOS, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:ZAMBOS
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 1:605 N WASHINGTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2107
Mailing Address - Country:US
Mailing Address - Phone:321-383-2630
Mailing Address - Fax:321-269-8313
Practice Address - Street 1:605 N WASHINGTON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2107
Practice Address - Country:US
Practice Address - Phone:321-383-2630
Practice Address - Fax:321-269-8313
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056144208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL035429500Medicaid
FL08733Medicare ID - Type Unspecified
FLA72407Medicare UPIN