Healthcare Provider Details

I. General information

NPI: 1508093071
Provider Name (Legal Business Name): YOUSSEF ZEIDAN MD/PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 07/19/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 NW 13TH ST
BOCA RATON FL
33486-2305
US

IV. Provider business mailing address

701 NW 13TH ST
BOCA RATON FL
33486-2305
US

V. Phone/Fax

Practice location:
  • Phone: 561-955-4116
  • Fax: 561-955-5347
Mailing address:
  • Phone: 561-955-4116
  • Fax: 561-955-5347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberA113666
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME119766
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: