Provider Demographics
NPI:1649506569
Name:B & L MEDICAL MANAGEMENT , INC.
Entity type:Organization
Organization Name:B & L MEDICAL MANAGEMENT , INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANESTHESIOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:JAWAHIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-961-0511
Mailing Address - Street 1:3190 S STATE ROAD 7
Mailing Address - Street 2:SUITE 12-B
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-5280
Mailing Address - Country:US
Mailing Address - Phone:954-961-0511
Mailing Address - Fax:954-961-0519
Practice Address - Street 1:3190 S STATE ROAD 7
Practice Address - Street 2:SUITE 12-B
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-5280
Practice Address - Country:US
Practice Address - Phone:954-961-0511
Practice Address - Fax:954-961-0519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64562207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373777200Medicaid
FLK0722AMedicare PIN
FL373777200Medicaid