Provider Demographics
NPI:1336162916
Name:AWAD, AMIR T (MD, FACG, FACP)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:T
Last Name:AWAD
Suffix:
Gender:M
Credentials:MD, FACG, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 EXECUTIVE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-5323
Mailing Address - Country:US
Mailing Address - Phone:727-347-0005
Mailing Address - Fax:727-541-6558
Practice Address - Street 1:11912 SHELDON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-3643
Practice Address - Country:US
Practice Address - Phone:813-920-8882
Practice Address - Fax:813-920-8883
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104226207RG0100X
NY002595207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME 104226OtherMEDICAL LICENSE
NY02779082Medicaid
FLME 104226OtherMEDICAL LICENSE