MEDICARE: MR. JAWAD SAMIR FARHAT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	ME74226	FL
2	207R00000X	Internal Medicine Physician	ME74226	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114034709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAWAD SAMIR FARHAT MD

Provider Business Mailing Address
First Line	:	1000 PLANTATION ISLAND DR S STE 9
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32080-3106
Country	:	US
Telephone Number	:	904-460-9191
Fax Number	:	904-471-4859

Provider Business Practice Location Address
First Line	:	1000 PLANTATION ISLAND DR S STE 9
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32080-3106
Country	:	US
Telephone Number	:	904-460-9191
Fax Number	:	904-471-4859

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	06/16/2026

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