Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ME95499 | FL |
N | 111NI0900X | Internist | ME95499 | FL |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | ME95499 | FL |
N | 207RG0300X | Geriatric Medicine | ME95499 | FL |
NPI | 1154382430 |
---|---|
Provider Name | Dr. Arshag Dertad Mooradian |
First Address | Jacksonville, FL 32231-4008 |
Second Address | Jacksonville, FL 32209-6511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 02/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2749777-00 | (05) | FL |
632720059A | (05) | GA |
E82912 | (02) | FL |
P00341448 | RAILROAD MEDICARE (01) | FL |