Provider Demographics
NPI:1194717306
Name:ZACHARY, JAMES MARK (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MARK
Last Name:ZACHARY
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 1:12109 COUNTY ROAD 103
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-2951
Mailing Address - Country:US
Mailing Address - Phone:352-205-8981
Mailing Address - Fax:
Practice Address - Street 1:1840 MEASE DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695
Practice Address - Country:US
Practice Address - Phone:727-785-6011
Practice Address - Fax:727-787-6951
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50144208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047727300Medicaid
D69026Medicare UPIN
FL03941Medicare ID - Type Unspecified