Provider Demographics
NPI:1740244805
Name:KAWWAFF, OMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:KAWWAFF
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 1:4123 UNIVERSITY BLVD S
Mailing Address - Street 2:SUITE A
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4371
Mailing Address - Country:US
Mailing Address - Phone:904-737-2801
Mailing Address - Fax:904-737-2441
Practice Address - Street 1:4123 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE A
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4371
Practice Address - Country:US
Practice Address - Phone:904-737-2801
Practice Address - Fax:904-737-2441
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 50380207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055732300Medicaid
FL110051678OtherRAILRAOD MEDICARE
FL055732300Medicaid
FL110051678OtherRAILRAOD MEDICARE