Active NPI
Peyman Mazidi, M.D.
- Internal Medicine Physician
- Jacksonville, FL
National Provider Identifier
1366633216
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- TRN11029
- Practice address
- 653 W 8TH St # L18
LRC, 4TH Floor
Jacksonville, FL 32209-6511 - Phone
- (904) 244-3086
- Fax
- (904) 244-3634
- NPI assigned
- Aug 6, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | TRN11029 | FL | Primary |
Addresses
Primary practice location
653 W 8TH St # L18
LRC, 4TH Floor
Jacksonville, FL 32209-6511
Mailing address
PO Box 335
Gosford, NEW SOUTH WALES 2250
AU
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TRN11029 | FL | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186358400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1200528000000",
"number": "1366633216",
"addresses": [
{
"country_code": "AU",
"country_name": "Australia",
"address_purpose": "MAILING",
"address_type": "FGN",
"address_1": "PO BOX 335",
"city": "GOSFORD",
"state": "NEW SOUTH WALES",
"postal_code": "2250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "653 W 8TH ST # L18",
"address_2": "LRC, 4TH FLOOR",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322096511",
"telephone_number": "904-244-3086",
"fax_number": "904-244-3634"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAZIDI",
"first_name": "PEYMAN",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-08-06",
"last_updated": "2008-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "FL",
"license": "TRN11029",
"primary": true
}
],
"identifiers": [],
"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 Jan 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.