Organization
JAX OB-GYN PA
Active
Other names
Hormoz Khosravi, MD
Organization subpart
No
Provider details
NPI number
Authorized official
HORMOZ KHOSRAVI (DR./OWNER)
(904) 737-1920
Entity
Organization
Contact information
Practice address
4123 UNIVERSITY BLVD S., SUITE D, JACKSONVILLE, FL 32216
(904) 737-1920
(904) 737-8932
Mailing address
4123 UNIVERSITY BLVD S., SUITE D, JACKSONVILLE, FL 32216
(904) 737-1920
(904) 737-8932
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
ME32812
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
037158100
—
FL
Enumeration date
04/23/2010
Last updated
12/30/2011
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