Provider Demographics
NPI:1932491867
Name:ZEIDAN, ISSA JASON (MD)
Entity Type:Individual
Prefix:DR
First Name:ISSA
Middle Name:JASON
Last Name:ZEIDAN
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 1:210 RINEHART RD
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2514
Mailing Address - Country:US
Mailing Address - Phone:321-841-1869
Mailing Address - Fax:321-842-3498
Practice Address - Street 1:210 RINEHART RD
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2514
Practice Address - Country:US
Practice Address - Phone:321-841-1869
Practice Address - Fax:321-842-3498
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301099013207Q00000X
VA0101258358207Q00000X
FLME121800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114502400Medicaid