Healthcare Provider Details

I. General information

NPI: 1528441904
Provider Name (Legal Business Name): ZAIN BARNOUTI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2015
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 BELFORT RD STE 3004
JACKSONVILLE FL
32216-1474
US

IV. Provider business mailing address

9310 OLD KINGS S RD 1201
JACKSONVILLE FL
32257-6196
US

V. Phone/Fax

Practice location:
  • Phone: 904-450-7060
  • Fax:
Mailing address:
  • Phone: 904-636-9197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO 3735
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberPO 3735
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO 3735
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: