Individual
IGOR IANOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
655 W 8TH ST, UFJP ANESTHESIA, JACKSONVILLE, FL 32209-6511
(904) 244-4195
Mailing address
PO BOX 44008, UFJP PROVIDER ENROLLMENT, JACKSONVILLE, FL 32231-4008
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
ME106625
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0022922-00
—
FL
Enumeration date
04/25/2007
Last updated
07/28/2010
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