Individual
ALIREZA BAZOOBAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 PRUDENTIAL DR, JACKSONVILLE, FL 32207
(904) 202-1347
(904) 202-3232
Mailing address
800 PRUDENTIAL DR, C/O BRENDA BAGGETT, JACKSONVILLE, FL 32207
(904) 202-1347
(904) 202-3232
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
ME90006
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00351519
RAILROAD MEDICARE
FL
Enumeration date
07/08/2006
Last updated
11/01/2007
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