Healthcare Provider Details

I. General information

NPI: 1881774321
Provider Name (Legal Business Name): DHIAA ZAKI DAOUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11375 CORTEZ BLVD
BROOKSVILLE FL
34613-5409
US

IV. Provider business mailing address

4 CREEK BLUFF WAY
ORMOND BEACH FL
32174-6724
US

V. Phone/Fax

Practice location:
  • Phone: 352-592-2755
  • Fax: 352-591-2753
Mailing address:
  • Phone: 954-684-3430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS0040959
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN28230
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME152285
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: