Provider Demographics
NPI:1740332485
Name:SOTO, ZATCHEL JOAQUIN (MD)
Entity type:Individual
Prefix:DR
First Name:ZATCHEL
Middle Name:JOAQUIN
Last Name:SOTO
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 1:2240 HWY 98
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830
Mailing Address - Country:US
Mailing Address - Phone:863-529-7039
Mailing Address - Fax:
Practice Address - Street 1:17240 CORTEZ BLVD
Practice Address - Street 2:BROOKSVILLE REGIONAL HOSPITAL
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-8978
Practice Address - Country:US
Practice Address - Phone:352-544-6061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78008207Q00000X
NMMD2015-0147207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2565455-00Medicaid
FL2565455-00Medicaid
FL466326CMedicare ID - Type UnspecifiedMEDICARE