Individual
DARYOUSH TAVANAIEPOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
580 W 8TH ST, TOWER1 8TH FLOOR, JACKSONVILLE, FL 32209-6533
(904) 383-1022
(904) 244-9430
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
0101247523
VA
207T00000X
Neurological Surgery Physician
Primary
ME113574
FL
390200000X
Student in an Organized Health Care Education/Training Program
0116016383
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003125606A
—
GA
05
—
005931400
—
FL
01
—
14KZ4
BCBSFL
FL
Enumeration date
05/22/2007
Last updated
09/05/2012
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