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General NPI Number Information
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NPI Number | 1366854317
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Entity Type | Organization
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Legal Business Name | BEHZAD RAZAVI, MD, PA
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Dates
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Enumeration Date | 05/27/2014
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Last Update Date | 05/27/2014
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Provider Practice Location Address
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Address Line | 870 MACK BAYOU RD
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-7150
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Country | US
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Telephone | 850-830-9452
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Fax |
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Provider Business Mailing Address
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Address Line | 755 GRAND BLVD SUITE B105-195
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City | MIRAMAR BEACH
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State | FL
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Zip | 32550-1838
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BEHZAD RAZAVI
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Credential | MD
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Telephone | 850-830-9452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | ME113682
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License Number State | FL
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