Healthcare Provider Details

I. General information

NPI: 1598050700
Provider Name (Legal Business Name): REZA HEJAZI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: REZA HEJAZI M.D.

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 SAN PABLO ROAD MAYO CLINIC
JACKSONVILLE FL
32224
US

IV. Provider business mailing address

2340 COVINGTON CREEK DR W
JACKSONVILLE FL
32224
US

V. Phone/Fax

Practice location:
  • Phone: 904-953-6970
  • Fax:
Mailing address:
  • Phone: 915-545-3018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBP10040403
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: