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NPI Code Detail

MEDICARE: DR. JAIME ZENGOTITA MD

MEDICARE: DR. JAIME ZENGOTITA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician2004017285MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093896201
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAIME ZENGOTITA MD
Provider Business Mailing Address
First Line : PO BOX 2580
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65801-2580
Country : US
Telephone Number : 417-829-4620
Fax Number : 417-829-4316
Provider Business Practice Location Address
First Line : 4352 MANCHESTER AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63110-2138
Country : US
Telephone Number : 314-531-5444
Fax Number : 314-531-0063
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2006
Last Update Date : 09/20/2024

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