Provider Demographics
NPI:1649280041
Name:KALTER, ZANE GARY (MD)
Entity type:Individual
Prefix:DR
First Name:ZANE
Middle Name:GARY
Last Name:KALTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3266
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32085-3266
Mailing Address - Country:US
Mailing Address - Phone:904-819-4602
Mailing Address - Fax:904-819-4426
Practice Address - Street 1:70 TURIN TER STE 220
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-0850
Practice Address - Country:US
Practice Address - Phone:904-819-3000
Practice Address - Fax:904-819-3201
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-00665208000000X
FLME0026524208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
D55495Medicare UPIN