MEDICARE: DR. FAWAZ M ASHOURI M.D.

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	208800000X	Urology Physician	ME38972	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	:	1912967860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FAWAZ M ASHOURI M.D.

Provider Business Mailing Address
First Line	:	2301 UNIVERSITY BLVD W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2022
Country	:	US
Telephone Number	:	904-396-3700
Fax Number	:	904-398-3871

Provider Business Practice Location Address
First Line	:	2301 UNIVERSITY BLVD W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217
Country	:	US
Telephone Number	:	904-396-3700
Fax Number	:	904-398-3871

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	05/21/2019

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