Provider Demographics
NPI:1578669933
Name:HUSSAIN, JAWED (MD)
Entity Type:Individual
Prefix:DR
First Name:JAWED
Middle Name:
Last Name:HUSSAIN
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:PO BOX 57970
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32241-7970
Mailing Address - Country:US
Mailing Address - Phone:904-306-9860
Mailing Address - Fax:904-306-9864
Practice Address - Street 1:4063 SALISBURY RD STE 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6199
Practice Address - Country:US
Practice Address - Phone:904-717-9625
Practice Address - Fax:904-683-6499
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME522152081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049131400Medicaid
FL05624OtherBCBS
FL250013790OtherRAILROAD MEDICARE
FLD21033Medicare UPIN
FL049131400Medicaid