Individual
BORNA MEHRAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1600 SW ARCHER RD # 100225, GAINESVILLE, FL 32610
(352) 273-8740
(352) 273-9154
Mailing address
PO BOX 100225, GAINESVILLE, FL 32610-0225
(352) 273-8740
(352) 273-9154
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
0101240380
VA
207RP1001X
Pulmonary Disease Physician
Primary
ME132544
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021382400
—
FL
01
—
JA388Z
MEDICARE PTAN
—
Enumeration date
04/12/2006
Last updated
06/11/2018
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