Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | ME 31963 | FL |
NPI | 1033104625 |
---|---|
Provider Name | Dr. Jack Zeltzer |
First Address | Atlantis, FL 33462-6641 |
Second Address | Atlantis, FL 33462-6641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
066949100 | (05) | FL |
D82245 | (02) |