Individual
MARY BRANAN ENNIS ZAHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
820 PRUDENTIAL DR, SUITE 713, JACKSONVILLE, FL 32207-8210
(904) 396-5682
Mailing address
820 PRUDENTIAL DR, SUITE 713, JACKSONVILLE, FL 32207-8210
(904) 396-5682
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
63859
GA
207P00000X
Emergency Medicine Physician
Primary
ME 107442
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002687800
—
FL
01
—
148Y4
BLUE CROSS
FL
05
—
643928689A
—
GA
Enumeration date
05/29/2007
Last updated
11/18/2011
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