Individual
DR. SINA OGHOLIKHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
807 CHILDRENS WAY, JACKSONVILLE, FL 32207-8426
(904) 697-3600
(904) 697-3927
Mailing address
10140 CENTURION PKWY N, PROVIDER ENROLLMENT DEPARTMENT, JACKSONVILLE, FL 32256-0532
(904) 697-4127
(904) 697-5102
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
15898
FL
2080P0206X
Pediatric Gastroenterology Physician
Primary
ME129261
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021016200
—
FL
Enumeration date
05/27/2011
Last updated
07/21/2022
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