Healthcare Provider Details

I. General information

NPI: 1679716344
Provider Name (Legal Business Name): HAITAO ZHANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 GREENLAND RD STE 804
JACKSONVILLE FL
32258-7436
US

IV. Provider business mailing address

6100 GREENLAND RD STE 804
JACKSONVILLE FL
32258-7436
US

V. Phone/Fax

Practice location:
  • Phone: 904-718-6929
  • Fax:
Mailing address:
  • Phone: 904-718-6929
  • Fax: 904-201-4057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME120029
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME120029
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME120029
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME120029
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: