Provider Demographics
NPI:1275527756
Name:MOURADIAN, ROBERT DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DAVID
Last Name:MOURADIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7629 SENTRY OAK CIR E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2323
Mailing Address - Country:US
Mailing Address - Phone:904-476-3616
Mailing Address - Fax:
Practice Address - Street 1:9726 TOUCHTON RD STE 305
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-8307
Practice Address - Country:US
Practice Address - Phone:904-686-6020
Practice Address - Fax:904-619-8879
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076224207L00000X
FLME75337207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17210YMedicare PIN
FL17210ZMedicare PIN