Provider Demographics
NPI:1437374923
Name:ROBERT D MOURADIAN PA
Entity Type:Organization
Organization Name:ROBERT D MOURADIAN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MOURADIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-476-3616
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7020Medicare PIN