Provider Demographics
NPI:1861583197
Name:ZUCKER, IRA A (MD)
Entity type:Individual
Prefix:
First Name:IRA
Middle Name:A
Last Name:ZUCKER
Suffix:
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:MANAGED CARE DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:7451 GLADIOLUS DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-5193
Practice Address - Country:US
Practice Address - Phone:239-689-8800
Practice Address - Fax:239-939-7774
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57412208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10293OtherBCBS PROVIDER #
FL1689688OtherCIGNA PRIOVIDER #
FL1193525OtherWELLCARE
FL208980OtherAVMED PROVIDER #
FLP00387302OtherRAILROAD MEDICARE
FL4133111OtherAETNA PROVIDER #
FL10293WMedicare PIN
FL10293YMedicare PIN
FLD42282Medicare UPIN
FL10293XMedicare PIN