Healthcare Provider Details

I. General information

NPI: 1083795637
Provider Name (Legal Business Name): HAGHIGHI FAMILY & SPORTS MEDICINE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 05/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9191 RG SKINNER PRKWY SUITE 901
JACKSONVILLE FL
32256
US

IV. Provider business mailing address

9191 RG SKINNER PRKWY SUITE 901
JACKSONVILLE FL
32256
US

V. Phone/Fax

Practice location:
  • Phone: 904-519-8895
  • Fax:
Mailing address:
  • Phone: 904-519-8895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL HAGHIGHI
Title or Position: OWNER DOCTOR
Credential: M.D.
Phone: 904-519-8895