Provider Demographics
NPI:1184668618
Name:ZAPATA, JUAN (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:ZAPATA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15895 MEADOWLARK CT
Mailing Address - Street 2:
Mailing Address - City:LOX
Mailing Address - State:FL
Mailing Address - Zip Code:33470-7008
Mailing Address - Country:US
Mailing Address - Phone:239-470-5539
Mailing Address - Fax:
Practice Address - Street 1:12797 FOREST HILL BLVD STE B
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4763
Practice Address - Country:US
Practice Address - Phone:561-467-5232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME115658207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010386300Medicaid
FLHR042ZMedicare PIN
IL1605620OtherBLUE SHIELD
IL210172Medicare ID - Type Unspecified
ILP00282683OtherRAILROAD MEDICARE
IL036110036Medicaid