Healthcare Provider Details

I. General information

NPI: 1013571496
Provider Name (Legal Business Name): BASSEM SALTI ZEIDAN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9332 STATE ROAD 54 STE 202
NEW PORT RICHEY FL
34655-1810
US

IV. Provider business mailing address

9332 SR 54 STE 202
NEW PORT RICHEY FL
34655-1810
US

V. Phone/Fax

Practice location:
  • Phone: 727-597-4441
  • Fax:
Mailing address:
  • Phone: 727-597-4441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME156570
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME156570
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME156570
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: