Provider Demographics
NPI:1548207780
Name:TIURCHY, PAYVAND (MD)
Entity type:Individual
Prefix:DR
First Name:PAYVAND
Middle Name:
Last Name:TIURCHY
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 45443
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84145-0443
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:14011 BEACH BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-1507
Practice Address - Country:US
Practice Address - Phone:904-992-1601
Practice Address - Fax:904-992-1621
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055285207Q00000X
FLME89386207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279505100Medicaid
GA278552248AMedicaid
FLAI378ZMedicare PIN
I13076Medicare UPIN
FL279505100Medicaid
GA08BBRDDMedicare ID - Type Unspecified