Healthcare Provider Details

I. General information

NPI: 1306280102
Provider Name (Legal Business Name): JERRY SIMBARASHE ZIFODYA M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 TULANE AVE
NEW ORLEANS LA
70112
US

IV. Provider business mailing address

1430 TULANE AVE # 8509
NEW ORLEANS LA
70112-2632
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-5263
  • Fax:
Mailing address:
  • Phone: 504-988-3541
  • Fax: 504-988-2144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number321061
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number321061
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: