Provider Demographics
NPI:1073772331
Name:JIAO, ZHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ZHEN
Middle Name:
Last Name:JIAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0967
Mailing Address - Country:US
Mailing Address - Phone:352-354-9000
Mailing Address - Fax:
Practice Address - Street 1:4224 HOUMA BLVD
Practice Address - Street 2:STE 300
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2936
Practice Address - Country:US
Practice Address - Phone:500-503-6618
Practice Address - Fax:504-503-6189
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD 202357207R00000X, 207RC0001X
MN54456207RC0001X
FLME164653207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
IAENROLLEDMedicaid
MN210000002Medicare PIN