Healthcare Provider Details

I. General information

NPI: 1114034709
Provider Name (Legal Business Name): JAWAD SAMIR FARHAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 PLANTATION ISLAND DR S STE 9
SAINT AUGUSTINE FL
32080-3106
US

IV. Provider business mailing address

1000 PLANTATION ISLAND DR S STE 9
SAINT AUGUSTINE FL
32080-3106
US

V. Phone/Fax

Practice location:
  • Phone: 904-460-9191
  • Fax: 904-471-4859
Mailing address:
  • Phone: 904-460-9191
  • Fax: 904-471-4859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME74226
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME74226
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: