Provider Demographics
NPI:1427286608
Name:ANAVIAN, JACK (MD)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:ANAVIAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2943 HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4411
Mailing Address - Country:US
Mailing Address - Phone:850-914-7060
Mailing Address - Fax:850-914-7065
Practice Address - Street 1:2 DUDLEY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-3236
Practice Address - Country:US
Practice Address - Phone:401-444-3581
Practice Address - Fax:401-444-3609
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2021-10-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RI14549207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery