MEDICARE: MARK E JAWAHIR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332900000X	Non-Pharmacy Dispensing Site	ME64562	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1016078	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1669415444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK E JAWAHIR MD

Provider Business Mailing Address
First Line	:	1763 US HIGHWAY 27 S
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-4920
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1763 US HIGHWAY 27 S
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-4920
Country	:	US
Telephone Number	:	863-402-0244
Fax Number	:	863-402-0243

Authorized Official
Title or Position	:	PRES
Name	:	DESTRY SETSER
Credential	:
Telephone Number	:	800-333-9800

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	08/22/2020

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Directions to “MARK E JAWAHIR MD ” Practice Location

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