Healthcare Provider Details

I. General information

NPI: 1568283232
Provider Name (Legal Business Name): ALI ZGHEIB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W 8TH ST
JACKSONVILLE FL
32209-6511
US

IV. Provider business mailing address

1900 OLEVIA ST APT 461
JACKSONVILLE FL
32207-3492
US

V. Phone/Fax

Practice location:
  • Phone: 904-383-1011
  • Fax:
Mailing address:
  • Phone: 904-219-0331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME170955
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: