Provider Demographics
NPI:1093769614
Name:BROYER, ZACH (MD)
Entity type:Individual
Prefix:
First Name:ZACH
Middle Name:
Last Name:BROYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21110 BISCAYNE BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1251
Mailing Address - Country:US
Mailing Address - Phone:954-458-1199
Mailing Address - Fax:954-458-1833
Practice Address - Street 1:2820 NE 214TH ST STE 701
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1269
Practice Address - Country:US
Practice Address - Phone:954-458-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1464382081P2900X, 208VP0014X
NJ25MA80275002081P2900X
PAMD074300L2081P2900X
PAMD-074300-L2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5005060OtherCIGNA
PA2074348000OtherIBC
PA2886235OtherAETNA
PA2886235OtherAETNA
PA250014135Medicare PIN
PA057331GC6Medicare PIN