MEDICARE: SAFWAN JAALOUK 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	207RI0011X	Interventional Cardiology Physician	19947	AL
2	207RI0011X	Interventional Cardiology Physician	ME71797	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619977121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAFWAN JAALOUK MD

Provider Business Mailing Address
First Line	:	125 BAPTIST WAY STE 3A
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32503-2274
Country	:	US
Telephone Number	:	448-227-6604
Fax Number	:	850-857-1747

Provider Business Practice Location Address
First Line	:	125 BAPTIST WAY STE 3A
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32503-2274
Country	:	US
Telephone Number	:	448-227-6604
Fax Number	:	850-857-1747

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	03/19/2024

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Directions to “ SAFWAN JAALOUK MD” Practice Location

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