Provider Demographics
NPI:1306470836
Name:BACHMANN, JOSHUA ZACHARY
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ZACHARY
Last Name:BACHMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7423 ANTIETAM CT E
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-9202
Mailing Address - Country:US
Mailing Address - Phone:407-467-3869
Mailing Address - Fax:
Practice Address - Street 1:7423 ANTIETAM CT E
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-9202
Practice Address - Country:US
Practice Address - Phone:407-467-3869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLB255439930880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine