Provider Demographics
NPI:1255658696
Name:JEAN PIERRE AWAIDA MD PA
Entity Type:Organization
Organization Name:JEAN PIERRE AWAIDA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN-PIERRE
Authorized Official - Middle Name:S
Authorized Official - Last Name:AWAIDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-499-3919
Mailing Address - Street 1:601 N CONGRESS AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-4639
Mailing Address - Country:US
Mailing Address - Phone:561-499-3919
Mailing Address - Fax:561-499-4338
Practice Address - Street 1:601 N CONGRESS AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-4639
Practice Address - Country:US
Practice Address - Phone:561-499-3919
Practice Address - Fax:561-499-4338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101406207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCU306AMedicare PIN