Provider Demographics
NPI:1619366937
Name:DOUGLAS, ZACHARIAH II (MD)
Entity type:Individual
Prefix:
First Name:ZACHARIAH
Middle Name:
Last Name:DOUGLAS
Suffix:II
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 1:13851 ROD AND GUN CLUB RD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-9619
Mailing Address - Country:US
Mailing Address - Phone:239-368-6677
Mailing Address - Fax:
Practice Address - Street 1:13851 ROD AND GUN CLUB RD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-9619
Practice Address - Country:US
Practice Address - Phone:239-368-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 691862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry