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General NPI Number Information
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NPI Number | 1407004658
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Entity Type | Organization
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Legal Business Name | REZA M TABA MD PA
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Dates
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Enumeration Date | 08/29/2008
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Last Update Date | 09/08/2008
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Provider Practice Location Address
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Address Line | 3599 UNIVERSITY BLVD S SUITE # 1201
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4252
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Country | US
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Telephone | 904-399-4185
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Fax | 904-396-2628
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Provider Business Mailing Address
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Address Line | 3599 UNIVERSITY BLVD S SUITE # 1201
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4252
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Country | US
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Telephone | 904-399-4185
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Fax | 904-396-2628
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. REZA MOHAMMAD TABA
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Credential | M.D.
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Telephone | 904-399-4185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | ME0047087
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License Number State | FL
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