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General NPI Number Information
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NPI Number | 1992982722
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Entity Type | Organization
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Legal Business Name | RAUL B ZELAYA MD PA
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Dates
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Enumeration Date | 01/23/2008
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Last Update Date | 01/23/2008
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Provider Practice Location Address
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Address Line | 1188 SW MAIN BLVD
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City | LAKE CITY
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State | FL
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Zip | 32025-6684
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Country | US
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Telephone | 386-752-6506
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Fax | 386-752-6508
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Provider Business Mailing Address
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Address Line | 1188 SW MAIN BLVD
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City | LAKE CITY
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State | FL
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Zip | 32025-6684
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Country | US
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Telephone | 386-752-6506
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Fax | 386-752-6508
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Authorized Official
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Title or Position | PRESDIENT
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Name | DR. RAUL B ZELAYA
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Credential | M.D.
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Telephone | 386-752-6506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | ME34230
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License Number State | FL
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