Active NPI
Alireza Bazooband, MD
- Anatomic Pathology & Clinical Pathology Physician
- Jacksonville, FL
National Provider Identifier
1124051826
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- ME90006
- Practice address
- 800 Prudential Dr
Jacksonville, FL 32207 - Phone
- (904) 202-1347
- Fax
- (904) 202-3232
- NPI assigned
- Jul 8, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | ME90006 | FL | Primary |
Addresses
Primary practice location
800 Prudential Dr
Jacksonville, FL 32207
Mailing address
800 Prudential Dr
C/O Brenda Baggett
Jacksonville, FL 32207
Phone (904) 202-1347
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00351519 | Other | FL | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME90006 | FL | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152316800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193875200000",
"number": "1124051826",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 PRUDENTIAL DR",
"address_2": "C/O BRENDA BAGGETT",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "32207",
"telephone_number": "904-202-1347",
"fax_number": "904-202-3232"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 PRUDENTIAL DR",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "32207",
"telephone_number": "904-202-1347",
"fax_number": "904-202-3232"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAZOOBAND",
"first_name": "ALIREZA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-08",
"last_updated": "2007-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "FL",
"license": "ME90006",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00351519",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.