Healthcare Provider Details

I. General information

NPI: 1437104999
Provider Name (Legal Business Name): JAMAL A ZEREIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 S SAM HOUSTON BLVD
HOUSTON MO
65483-2046
US

IV. Provider business mailing address

1333 S SAM HOUSTON BLVD
HOUSTON MO
65483-2046
US

V. Phone/Fax

Practice location:
  • Phone: 417-967-3311
  • Fax: 417-967-1259
Mailing address:
  • Phone: 417-967-3311
  • Fax: 417-967-1259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number119678
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number119678
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number119678
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: