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General NPI Number Information
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NPI Number | 1457560906
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Entity Type | Individual
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Provider Name | DARYOUSH TAVANAIEPOUR MD
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Gender | Male
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 09/05/2012
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Provider Practice Location Address
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Address Line | 580 W 8TH ST TOWER1 8TH FLOOR
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City | JACKSONVILLE
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State | FL
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Zip | 32209-6533
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Country | US
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Telephone | 904-383-1022
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Fax | 904-244-9430
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Provider Business Mailing Address
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Address Line | PO BOX 44008
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City | JACKSONVILLE
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State | FL
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Zip | 32231-4008
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Country | US
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Telephone | 904-244-3660
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Fax | 904-244-3425
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 0101247523
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 0116016383
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | ME113574
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License Number State | FL
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