Individual
DR. KOUROSH TAVANAIEPOUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
580 W 8TH ST, JACKSONVILLE, FL 32209-6533
(904) 383-1022
Mailing address
PO BOX 44008, JACKSONVILLE, FL 32231-4008
(904) 244-3660
(904) 244-3425
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
OS14713
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/19/2012
Last updated
03/17/2018
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