Basic Information
| Provider Information | |||||||||
| NPI: | 1003976671 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZENEL | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14540 CORTEZ BLVD. STE. 108 | ||||||||
| Address2: | BROOKSVILLE VA COMMUNITY BASED OUTPATIENT CLINIC | ||||||||
| City: | BROOKSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346130000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525978287 | ||||||||
| FaxNumber: | 3525979816 | ||||||||
| Practice Location | |||||||||
| Address1: | 14540 CORTEZ BLVD | ||||||||
| Address2: | BROOKSVILLE VA COMMUNITY BASED CLINIC, STE 108 | ||||||||
| City: | BROOKSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346136056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525878287 | ||||||||
| FaxNumber: | 3525977161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 04/03/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | ME55998 | FL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 370464500 | 05 | FL | MEDICAID |