JAX OB-GYN PA


Address: 4123 University Blvd S., Suite D, Jacksonville, FL 32216
Phone: 9047371920

JAX OB-GYN PA (NPI# 1891012365) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1891012365
Entity Type Organization
Organization Name JAX OB-GYN PA
Other Organization Name HORMOZ KHOSRAVI, MD
Practice Address 4123 University Blvd S.
Suite D
Jacksonville
FL 32216
Practice Telephone 9047371920
Practice Fax Number 9047378932
Mailing Telephone 9047371920
Mailing Fax Number 9047378932
Enumeration Date 2010-04-23
Last Update Date 2011-12-30
Authorized Official Name HORMOZ KHOSRAVI (DR./OWNER)
Authorized Official Telephone 9047371920
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207VG0400X Obstetrics & Gynecology
Specialization: Gynecology
ME32812 FL Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
FL 037158100 05

Other Provider/Organization Names

Other Name Type Code
Hormoz Khosravi, MD Other Name - Individual/Organization

Office Location

Street Address 4123 UNIVERSITY BLVD S.
SUITE D
City JACKSONVILLE
State FL
Zip Code 32216

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1154802833 John-paul Pham Internal Medicine 4141 Southpoint Drive East, Suite D, Jacksonville, FL 32216 2018-08-22
1790279479 Joseph Richard Kennedy Physician Assistant 6650 Corporate Center Pkwy Apt 1604, Jacksonville, FL 32216 2018-06-18
1801304357 Kelli M. Tyson Nurse Practitioner 3550 University Blvd. S., Ste 302, Jacksonville, FL 32216 2018-01-18
1376054809 Angela M Whittinghill Counselor 8833 Perimeter Park Blvd #702, Jacksonville, FL 32216 2017-10-24
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Taxonomy Information

Taxonomy Code 207VG0400X
Grouping Allopathic & Osteopathic Physicians
Classification Obstetrics & Gynecology
Specialization Gynecology

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1649737552 Joe Walker Bancroft Jr. Obstetrics & Gynecology 4618 Long Bow Rd. South, Jacksonville, FL 32210-8144 2019-02-27
1255865036 Dr. Frances Renee Montgomery Obstetrics & Gynecology 1432 Braden St Ste B, Jacksonville, AR 72076-3721 2017-04-18
1801044268 All Women's Health Center of Jacksonville, Inc. Obstetrics & Gynecology 4331 University Blvd S, Jacksonville, FL 32216-4909 2008-08-28
1699985457 Leslie Beadling Obstetrics & Gynecology 8160 Summit Ridge Ln, Jacksonville, FL 32256-7149 2007-05-23
1982700746 Donald S Freedman Md Pa Obstetrics & Gynecology 480 Busch Dr, Jacksonville, FL 32218-5553 2006-09-16
1043313653 The Womens Clinic Obstetrics & Gynecology 219 Station Street, Jacksonville, NC 28546 2006-09-07
1285677849 Kenneth Kushner Obstetrics & Gynecology 5111 Baymeadows Rd, Suite 8, Jacksonville, FL 32217-4800 2006-06-13
1982665279 Kristin P. Fernandez Obstetrics & Gynecology 14534 Old Saint Augustine Rd Ste 3430, Jacksonville, FL 32258-2460 2006-03-28
1790778025 Amy E Hearne Obstetrics & Gynecology 7051 Southpoint Pkwy S, Suite 200, Jacksonville, FL 32216-8713 2005-08-23
1295734531 Wilbur Cannon Simpson Obstetrics & Gynecology 7051 Southpoint Pkwy S Ste 200, Jacksonville, FL 32216-8713 2005-07-19
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Competitor

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City JACKSONVILLE
Zip Code 32216

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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