Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | F476 | CA |
Y | 208800000X | Urologist | TRN29478 | FL |
NPI | 1053859041 |
---|---|
Provider Name | Soroush Bazargani |
First Address | Jacksonville, FL 32216-6511 |
Second Address | Jacksonville, FL 32216-6511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2017 |
Last Update Date | 22/10/2019 |