Provider Demographics
NPI:1700060555
Name:NASERI, IMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:IMAN
Middle Name:
Last Name:NASERI
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 1:6817 SOUTHPOINT PARKWAY SUITE 502
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6289
Mailing Address - Country:US
Mailing Address - Phone:904-595-7475
Mailing Address - Fax:904-595-7480
Practice Address - Street 1:6817 SOUTHPOINT PARKWAY
Practice Address - Street 2:SUITE 502
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6289
Practice Address - Country:US
Practice Address - Phone:904-595-7475
Practice Address - Fax:904-595-7480
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056201207Y00000X
FLME105498207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01368157OtherRR MEDICARE
FL0013083-00Medicaid
GA478745301AMedicaid
FLP01368157OtherRR MEDICARE