Provider Demographics
NPI:1437104999
Name:ZEREIK, JAMAL A (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMAL
Middle Name:A
Last Name:ZEREIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1333 S SAM HOUSTON BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MO
Mailing Address - Zip Code:65483-2046
Mailing Address - Country:US
Mailing Address - Phone:417-967-3311
Mailing Address - Fax:417-967-1259
Practice Address - Street 1:1333 S SAM HOUSTON BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MO
Practice Address - Zip Code:65483-2046
Practice Address - Country:US
Practice Address - Phone:417-967-3311
Practice Address - Fax:417-967-1259
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO119678208000000X, 208D00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204664015Medicaid
MO1437104999Medicaid
MO26D0446923OtherCLIA
MOG99887OtherUPIN
MO1437104999Medicaid
MO204664015Medicaid
MO906514748Medicare PIN