Provider Demographics
NPI:1336157619
Name:CARLOS A ZAPATA MD PA
Entity Type:Organization
Organization Name:CARLOS A ZAPATA MD PA
Other - Org Name:CARLOS A ZAPATA MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ALFREDO
Authorized Official - Last Name:ZAPATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-878-2113
Mailing Address - Street 1:2173 B CENTERVILLE PLACE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-8303
Mailing Address - Country:US
Mailing Address - Phone:850-878-2113
Mailing Address - Fax:850-878-2839
Practice Address - Street 1:2173 CENTERVILLE PL STE B
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-8303
Practice Address - Country:US
Practice Address - Phone:850-878-2113
Practice Address - Fax:850-878-2839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME37183174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039817900Medicaid
FL039817900Medicaid
FLD54609Medicare UPIN