Provider Demographics
NPI:1477791069
Name:HOSSEINI, SEYED S (MD)
Entity Type:Individual
Prefix:DR
First Name:SEYED
Middle Name:S
Last Name:HOSSEINI
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 1:865 BLANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-8917
Mailing Address - Country:US
Mailing Address - Phone:904-276-1133
Mailing Address - Fax:904-276-1821
Practice Address - Street 1:865 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-8917
Practice Address - Country:US
Practice Address - Phone:904-276-1133
Practice Address - Fax:904-276-1821
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103360207Q00000X
FLME 103360261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009930000Medicaid