Provider Demographics
NPI:1457329591
Name:ZACHOS, THOMAS (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:ZACHOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ATHANASIOS
Other - Middle Name:
Other - Last Name:ZACHOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4154 BEACH DR
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2980
Mailing Address - Country:US
Mailing Address - Phone:850-376-8739
Mailing Address - Fax:
Practice Address - Street 1:1032 MAR WALT DR
Practice Address - Street 2:SUITE 240
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6661
Practice Address - Country:US
Practice Address - Phone:850-863-0883
Practice Address - Fax:850-862-0188
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38087208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46160OtherBCBS FL
FL4306752OtherAETNA
AL593-06486OtherBCBS AL
AL593-06487OtherBCBS AL
FL064335100Medicaid
FLD54972Medicare UPIN
FL46160WMedicare PIN