Provider Demographics
NPI:1942763941
Name:WHITNEY, ZACKARY BRYCE (DO)
Entity Type:Individual
Prefix:DR
First Name:ZACKARY
Middle Name:BRYCE
Last Name:WHITNEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 SUMMIT RIDGE PL APT 107
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-6251
Mailing Address - Country:US
Mailing Address - Phone:435-215-6012
Mailing Address - Fax:
Practice Address - Street 1:409 SUMMIT RIDGE PL APT 107
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-6251
Practice Address - Country:US
Practice Address - Phone:435-215-6012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6696207N00000X
FLOS17969207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology