Healthcare Provider Details

I. General information

NPI: 1003072794
Provider Name (Legal Business Name): ABDULSATTAR ZIDAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2008
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 CHERRY ST
MONTGOMERY AL
36107-2613
US

IV. Provider business mailing address

1020 SOUTHLAKE CV
HOOVER AL
35244-3282
US

V. Phone/Fax

Practice location:
  • Phone: 334-420-5001
  • Fax: 334-420-0158
Mailing address:
  • Phone: 304-840-3001
  • Fax: 205-238-5703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number31147
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: