Provider Demographics
NPI:1902867567
Name:ZAWAHRY, HEATHER S (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:S
Last Name:ZAWAHRY
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:PO BOX 1280
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32402-1280
Mailing Address - Country:US
Mailing Address - Phone:850-785-3464
Mailing Address - Fax:850-785-2791
Practice Address - Street 1:2101 NORTHSIDE DR UNIT 501
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3687
Practice Address - Country:US
Practice Address - Phone:850-785-3464
Practice Address - Fax:850-785-2791
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0084800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267798900Medicaid
FL81116OtherBCBS FLORIDA
FLH63659Medicare UPIN
FLE7508YMedicare PIN