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General NPI Number Information
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NPI Number | 1982728929
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Entity Type | Organization
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Legal Business Name | STONE SURGERY CLINIC
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 02/23/2009
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Provider Practice Location Address
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Address Line | 962 US 331 SOUTH
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City | DEFUNIAK SPRINGS
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State | FL
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Zip | 32435
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Country | US
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Telephone | 950-951-8800
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Fax | 950-951-0203
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Provider Business Mailing Address
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Address Line | 962 US HWY 331 SOUTH
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City | DEFUNIAK SPRINGS
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State | FL
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Zip | 32435
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Country | US
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Telephone | 950-951-8800
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Fax | 950-951-0203
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Authorized Official
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Title or Position | OWNER
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Name | DR. FAWZI FAWAZ
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Credential | M.D.
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Telephone | 850-951-8800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 82523
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License Number State | FL
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