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General NPI Number Information
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NPI Number | 1447477484
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Entity Type | Organization
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Legal Business Name | FAWAZ MEDICAL & SURGICAL CLINIC
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4417 US HWY 331 S
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City | DEFUNIAK SPGS
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State | FL
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Zip | 32435-6703
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Country | US
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Telephone | 850-951-4638
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Fax | 850-951-4554
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Provider Business Mailing Address
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Address Line | PO BOX 75
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City | DEFUNIAK SPGS
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State | FL
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Zip | 32435-0075
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Country | US
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Telephone | 850-951-4638
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Fax | 850-951-4554
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Authorized Official
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Title or Position | DO
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Name | SHARON S FAWAZ
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Credential | DO
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Telephone | 850-951-4638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number | OS8303
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License Number State | FL
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