Healthcare Provider Details

I. General information

NPI: 1841040318
Provider Name (Legal Business Name): FAWAZ OWAIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MEADOWS RD
BOCA RATON FL
33486-2304
US

IV. Provider business mailing address

6033 BEE BALM DR
FORT WORTH TX
76123-5066
US

V. Phone/Fax

Practice location:
  • Phone: 561-955-3945
  • Fax: 866-622-2185
Mailing address:
  • Phone: 682-365-6551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: