Healthcare Provider Details

I. General information

NPI: 1730176348
Provider Name (Legal Business Name): ARASTOO T NABIZADEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6816 SOUTHPOINT PKWY STE 201
JACKSONVILLE FL
32216-1701
US

IV. Provider business mailing address

PO BOX 17809
JACKSONVILLE FL
32245-7809
US

V. Phone/Fax

Practice location:
  • Phone: 904-281-1164
  • Fax: 904-281-7732
Mailing address:
  • Phone: 904-723-5665
  • Fax: 904-338-0951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME60706
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: