Provider Demographics
NPI:1043294960
Name:ERVANIAN, JAMES A (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:ERVANIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:851 TRAFALGAR CT.
Mailing Address - Street 2:SUITE 200E
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751
Mailing Address - Country:US
Mailing Address - Phone:407-667-0444
Mailing Address - Fax:407-667-4338
Practice Address - Street 1:820 PRUDENTIAL DR. STE 606
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32247-5278
Practice Address - Country:US
Practice Address - Phone:904-398-3356
Practice Address - Fax:904-398-5397
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0064376207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373160000Medicaid
FL373160000Medicaid
FL23284ZMedicare ID - Type Unspecified