Provider Demographics
NPI:1780691956
Name:BAZATA, JOHN (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:BAZATA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 W OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-4883
Mailing Address - Country:US
Mailing Address - Phone:407-855-0093
Mailing Address - Fax:407-857-8999
Practice Address - Street 1:827 W OAK RIDGE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4883
Practice Address - Country:US
Practice Address - Phone:407-855-0093
Practice Address - Fax:407-857-8999
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP00001048213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041187600Medicaid
FL87731Medicare ID - Type Unspecified
FL041187600Medicaid