Provider Demographics
NPI:1407004658
Name:REZA M TABA MD PA
Entity Type:Organization
Organization Name:REZA M TABA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:MOHAMMAD
Authorized Official - Last Name:TABA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-399-4185
Mailing Address - Street 1:3599 UNIVERSITY BLVD S
Mailing Address - Street 2:SUITE # 1201
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4252
Mailing Address - Country:US
Mailing Address - Phone:904-399-4185
Mailing Address - Fax:904-396-2628
Practice Address - Street 1:3599 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE # 1201
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4252
Practice Address - Country:US
Practice Address - Phone:904-399-4185
Practice Address - Fax:904-396-2628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-29
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0047087207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty