Provider Demographics
NPI:1235175191
Name:JAWDE, ANDRE FA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:FA
Last Name:JAWDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1449 MICCOSUKEE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5171
Mailing Address - Country:US
Mailing Address - Phone:850-942-2337
Mailing Address - Fax:850-942-2843
Practice Address - Street 1:1449 MICCOSUKEE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5171
Practice Address - Country:US
Practice Address - Phone:850-942-2337
Practice Address - Fax:850-942-2843
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME29007174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37227ZMedicare ID - Type Unspecified
FLD54586Medicare UPIN