Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207NS0135X | Procedural Dermatology | ME108867 | FL |
N | 208200000X | Surgeon | 35064102 | OH |
N | 208600000X | Surgeon | 35064102 | OH |
NPI | 1205815859 |
---|---|
Provider Name | John J Zelis |
First Address | Jacksonville, FL 32256-6017 |
Second Address | Jacksonville, FL 32256-6017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2006 |
Last Update Date | 21/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003472000 | (05) | FL |
2172527 | (05) | OH |
G84700 | (02) | OH |