Basic Information
| Provider Information | |||||||||
| NPI: | 1437374923 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROBERT D MOURADIAN PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7629 SENTRY OAK CIR E | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322562323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044763616 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9726 TOUCHTON RD STE 305 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322468307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046866020 | ||||||||
| FaxNumber: | 9046198879 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2007 | ||||||||
| LastUpdateDate: | 04/17/2020 | ||||||||
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| AuthorizedOfficialLastName: | MOURADIAN | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9044763616 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 04/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.