Individual
SHAHAB REZVANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
701 W PLYMOUTH AVE, DELAND, FL 32720-3236
(386) 943-3160
Mailing address
701 W PLYMOUTH AVE, DELAND, FL 32720-3236
(386) 943-3160
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301105203
MI
2085R0202X
Diagnostic Radiology Physician
4301501046
MI
2085R0202X
Diagnostic Radiology Physician
55364
KY
2085R0202X
Diagnostic Radiology Physician
Primary
ME145200
FL
Other
Enumeration date
05/02/2014
Last updated
09/24/2024
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