Provider Demographics
NPI:1750375671
Name:TAWAKOL, JAN B (MD)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:B
Last Name:TAWAKOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3004 ORANGE GROVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820-4288
Mailing Address - Country:US
Mailing Address - Phone:340-715-7720
Mailing Address - Fax:340-713-9002
Practice Address - Street 1:3004 ORANGE GROVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4288
Practice Address - Country:US
Practice Address - Phone:340-715-7720
Practice Address - Fax:340-713-9002
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1675207R00000X, 207RN0300X
FLME86769207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ898629Medicaid
AZ111010Medicare PIN
AZI23290Medicare UPIN
AZZ100490Medicare ID - Type Unspecified