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PEDRAM ZENDEHROUH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
951 N WASHINGTON AVE, PARRISH WOUND HEALING CENTER, TITUSVILLE, FL 32796-2163
(321) 268-6795
Mailing address
5220 BELFORT RD, SUITE 130, JACKSONVILLE, FL 32256-6017
(904) 446-3451
(904) 446-3013

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2004016404
MO
2086S0127X
Trauma Surgery Physician
2004016404
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
209022003
MO
01
431560263006
TRICARE
MO
01
P00195701
RAILROAD MEDICARE
MO
Enumeration date
11/30/2006
Last updated
01/26/2015
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