Provider Demographics
NPI:1568425205
Name:SABBAGH, RADWAN (MD)
Entity Type:Individual
Prefix:MR
First Name:RADWAN
Middle Name:
Last Name:SABBAGH
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 1:900 UNIVERSITY BLVD. NORTH
Mailing Address - Street 2:MC 75
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211
Mailing Address - Country:US
Mailing Address - Phone:904-253-2062
Mailing Address - Fax:904-253-1942
Practice Address - Street 1:5150-9 TIMUQUANA RD.
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210
Practice Address - Country:US
Practice Address - Phone:904-253-1120
Practice Address - Fax:904-253-2514
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66355208000000X, 2080P0207X
FLME66352080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2504456-00Medicaid
FL250445600Medicaid
FLG34336Medicare UPIN
FL31592ZMedicare PIN
FL250445600Medicaid