Provider Demographics
NPI:1962473264
Name:JAWAHIR, MARK E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:JAWAHIR
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 548
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33871-0548
Mailing Address - Country:US
Mailing Address - Phone:863-402-0244
Mailing Address - Fax:863-402-0243
Practice Address - Street 1:1759 1763 US HWY 27 SOUTH
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870
Practice Address - Country:US
Practice Address - Phone:863-402-0244
Practice Address - Fax:863-402-0243
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64562207L00000X, 208VP0000X, 202K00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373777200Medicaid
FL23582OtherBLUE CROSS BLUE SHIELD
FL593506993OtherAETNA/MULTIPLAN
FL373777200Medicaid
FL23582OtherBLUE CROSS BLUE SHIELD
FL23582BMedicare PIN
FL6385380001Medicare NSC