Jax OB-GYN PA

Primary specialty

Gynecology PhysicianTaxonomy code 207VG0400X

License

ME32812 Issued in FL

Legal business name

JAX OB-GYN PA

Practice address

4123 University Blvd S.
Suite D
Jacksonville, FL 32216

Phone

(904) 737-1920

Fax

(904) 737-8932

NPI assigned

Apr 23, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Hormoz Khosravi

Title

Dr./Owner

Phone

(904) 737-1920

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Hormoz Khosravi, MD Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1271980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325203200000",
    "number": "1891012365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4123 UNIVERSITY BLVD S.",
            "address_2": "SUITE D",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32216",
            "telephone_number": "904-737-1920",
            "fax_number": "904-737-8932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4123 UNIVERSITY BLVD S.",
            "address_2": "SUITE D",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32216",
            "telephone_number": "904-737-1920",
            "fax_number": "904-737-8932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAX OB-GYN PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-23",
        "last_updated": "2011-12-30",
        "status": "A",
        "authorized_official_last_name": "KHOSRAVI",
        "authorized_official_first_name": "HORMOZ",
        "authorized_official_title_or_position": "DR./OWNER",
        "authorized_official_telephone_number": "904-737-1920"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "FL",
            "license": "ME32812",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "037158100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hormoz Khosravi, MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Gynecology Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Gynecology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.