MEDICARE: HAITAO ZHANG MD, P.A.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	208VP0000X	Pain Medicine Physician
2	208VP0014X	Interventional Pain Medicine Physician
3	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician

General Provider Information

NPI Number	:	1356998975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAITAO ZHANG MD, P.A.

Provider Business Mailing Address
First Line	:	10175 FORTUNE PKWY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6746
Country	:	US
Telephone Number	:	904-718-6929
Fax Number	:	904-201-4057

Provider Business Practice Location Address
First Line	:	10175 FORTUNE PKWY UNIT 803
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6754
Country	:	US
Telephone Number	:	904-718-6929
Fax Number	:	904-201-4057

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HAITAO ZHANG
Credential	:	MD
Telephone Number	:	904-718-6929

Provider Enumeration Date	:	08/19/2019
Last Update Date	:	02/22/2022

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