Individual
PASSISD LAOVEERAVAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Mailing address
PO BOX 860912, MINNEAPOLIS, MN 55486-0912
(904) 953-2000
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
ME173483
FL
Other
Enumeration date
06/27/2017
Last updated
06/12/2025
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