Healthcare Provider Details

I. General information

NPI: 1871704221
Provider Name (Legal Business Name): DMITRIY ZUBKUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SHIRCLIFF WAY STE 625
JACKSONVILLE FL
32204-4776
US

IV. Provider business mailing address

3 SHIRCLIFF WAY STE 625
JACKSONVILLE FL
32204-4776
US

V. Phone/Fax

Practice location:
  • Phone: 904-308-6900
  • Fax: 904-308-6927
Mailing address:
  • Phone: 904-308-6900
  • Fax: 904-308-6927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD434242
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD434242
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME152827
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number0101272454
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME152827
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: