Provider Demographics
NPI:1982715033
Name:BEHZADI, FARAMARZ (MD)
Entity Type:Individual
Prefix:
First Name:FARAMARZ
Middle Name:
Last Name:BEHZADI
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 1:4123 UNIVERSITY BLVD S
Mailing Address - Street 2:SUITE F
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216
Mailing Address - Country:US
Mailing Address - Phone:904-731-9610
Mailing Address - Fax:904-730-7510
Practice Address - Street 1:4123 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE F
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-731-9610
Practice Address - Fax:904-730-7510
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME038839208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066094900Medicaid
FL15644Medicare ID - Type Unspecified
FL066094900Medicaid