Individual
BOUTROS ZEIDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
315 LOCUST ST, SUITE 5B, JOHNSTOWN, PA 15901-1651
(814) 535-2030
(814) 535-2031
Mailing address
315 LOCUST ST, SUITE 5B, JOHNSTOWN, PA 15901-1651
(814) 535-2030
(814) 535-2031
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD064590L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017225930005
—
PA
01
—
1507228
GATEWAY
PA
01
—
161817
HIGHMARK BLUE SHIELD
PA
01
—
99630
THREE RIVERS HEALTH PLAN
PA
Enumeration date
09/06/2005
Last updated
01/12/2011
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