Healthcare Provider Details

I. General information

NPI: 1043210560
Provider Name (Legal Business Name): NELSON ROBERT ZIDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 K SHERIDAN ST
HOLLYWOOD FL
33021-3416
US

IV. Provider business mailing address

4700 K SHERIDAN ST
HOLLYWOOD FL
33021-3416
US

V. Phone/Fax

Practice location:
  • Phone: 954-962-0040
  • Fax: 954-962-7901
Mailing address:
  • Phone: 954-962-0040
  • Fax: 954-962-7901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME13139
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME0013139
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: