Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | CH7262 | FL |
NPI | 1407073661 |
---|---|
Provider Name | Dr. Mehran Peter Ghazvini |
First Address | Tallahassee, FL 32301-3583 |
Second Address | Tallahassee, FL 32301-3583 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 08/07/2007 |