Healthcare Provider Details

I. General information

NPI: 1740244805
Provider Name (Legal Business Name): OMAR KAWWAFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 08/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4123 UNIVERSITY BLVD S SUITE A
JACKSONVILLE FL
32216-4371
US

IV. Provider business mailing address

4123 UNIVERSITY BLVD S SUITE A
JACKSONVILLE FL
32216-4371
US

V. Phone/Fax

Practice location:
  • Phone: 904-737-2801
  • Fax: 904-737-2441
Mailing address:
  • Phone: 904-737-2801
  • Fax: 904-737-2441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME 50380
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: