Provider Demographics
NPI:1386801116
Name:MOHAMMADIAN, ABDOLREZA (MD)
Entity type:Individual
Prefix:DR
First Name:ABDOLREZA
Middle Name:
Last Name:MOHAMMADIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 NORTH JEFFERSON STREET
Mailing Address - Street 2:VA OUTPATIENT CLINIC
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209
Mailing Address - Country:US
Mailing Address - Phone:904-475-5800
Mailing Address - Fax:904-301-2502
Practice Address - Street 1:1536 N.JEFFERSON STREET
Practice Address - Street 2:VA OUTPATIENT CLINIC
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-0000
Practice Address - Country:US
Practice Address - Phone:904-475-5800
Practice Address - Fax:904-301-2502
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME102692207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1386801116OtherFAMILY PRACTICE AND GERIATRIC MEDICINE