Individual
FERNANDO ZAYAS-BAZAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
807 CHILDRENS WAY, NEMOURS CHILDRENS CLINIC, JACKSONVILLE, JACKSONVILLE, FL 32207-8426
(904) 697-3600
Mailing address
PO BOX 191, PROVIDER ENROLLMENT DEPARTMENT, ROCKLAND, DE 19732-0191
(302) 651-6212
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
ME121049
FL
207LP3000X
Pediatric Anesthesiology Physician
Primary
ME121049
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015274400
—
FL
Enumeration date
04/23/2010
Last updated
09/26/2015
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