Organization
INNOVATIVE IMAGING ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NASSER RAZACK MD (OWNER)
(727) 374-2228
Entity
Organization
Contact information
Practice address
701 6TH ST S, ST PETERSBURG, FL 33701-4814
(727) 274-2228
Mailing address
PO BOX 309, PICKENS, SC 29671-0309
(864) 850-1441
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
ME92656
FL
2085R0204X
Vascular & Interventional Radiology Physician
ME92656
FL
2085U0001X
Diagnostic Ultrasound Physician
ME92656
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
277309100
—
FL
Enumeration date
01/02/2007
Last updated
06/21/2018
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