Basic Information
| Provider Information | |||||||||
| NPI: | 1275527756 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOURADIAN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7629 SENTRY OAK CIR E | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322562323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044763616 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9726 TOUCHTON RD STE 305 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322468307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046866020 | ||||||||
| FaxNumber: | 9046198879 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2005 | ||||||||
| LastUpdateDate: | 04/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 35076224 | OH | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | ME75337 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.