Provider Demographics
NPI:1962464685
Name:RAMEZANI, HOSSEIN (MD)
Entity type:Individual
Prefix:DR
First Name:HOSSEIN
Middle Name:
Last Name:RAMEZANI
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:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32067-0365
Mailing Address - Country:US
Mailing Address - Phone:904-269-1664
Mailing Address - Fax:904-264-4085
Practice Address - Street 1:1518 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4511
Practice Address - Country:US
Practice Address - Phone:904-269-1664
Practice Address - Fax:904-264-4085
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46469207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10988Medicare ID - Type Unspecified
FLD85008Medicare UPIN