Provider Demographics
NPI:1669415444
Name:MARK E JAWAHIR MD
Entity type:Organization
Organization Name:MARK E JAWAHIR MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:DESTRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SETSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-333-9800
Mailing Address - Street 1:1763 US HIGHWAY 27 S
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-4920
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1763 US HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-4920
Practice Address - Country:US
Practice Address - Phone:863-402-0244
Practice Address - Fax:863-402-0243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64562332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
1016078OtherOTHER ID NUMBER-COMMERCIAL NUMBER