Healthcare Provider Details

I. General information

NPI: 1356998975
Provider Name (Legal Business Name): HAITAO ZHANG MD, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10175 FORTUNE PKWY UNIT 803
JACKSONVILLE FL
32256-6754
US

IV. Provider business mailing address

10175 FORTUNE PKWY
JACKSONVILLE FL
32256-6746
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HAITAO ZHANG
Title or Position: PRESIDENT
Credential: MD
Phone: 904-718-6929