Provider Demographics
NPI:1619977121
Name:JAALOUK, SAFWAN (MD)
Entity Type:Individual
Prefix:
First Name:SAFWAN
Middle Name:
Last Name:JAALOUK
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 1:125 BAPTIST WAY STE 3A
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2274
Mailing Address - Country:US
Mailing Address - Phone:448-227-6604
Mailing Address - Fax:850-857-1747
Practice Address - Street 1:125 BAPTIST WAY STE 3A
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2274
Practice Address - Country:US
Practice Address - Phone:448-227-6604
Practice Address - Fax:850-857-1747
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19947207RI0011X
FLME71797207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000034396Medicaid
FL252068100Medicaid
FL252068100Medicaid
AL000034396Medicaid
AL000034396Medicaid