Provider Demographics
NPI:1861413106
Name:ZOUAIN, NICOLAS G (MD)
Entity type:Individual
Prefix:
First Name:NICOLAS
Middle Name:G
Last Name:ZOUAIN
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 1:12109 COUNTY ROAD 103
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-2951
Mailing Address - Country:US
Mailing Address - Phone:352-205-8981
Mailing Address - Fax:
Practice Address - Street 1:2560 ENTERPRISE RD E
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-1010
Practice Address - Country:US
Practice Address - Phone:727-796-5354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1042392085R0001X
ND100222085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004174400Medicaid
FLP116159OtherFREEDOM HEALTH
ND13509Medicaid
MN275492400Medicaid
FL7704762OtherAETNA
FL004174400Medicaid
FL365762OtherAVMED
FLP116159OtherFREEDOM HEALTH
FL6721428OtherCIGNA
FL10M894OtherHEALTHY KIDS
FL004174400Medicaid
FLP01210180OtherRAILROAD MCR