Provider Demographics
NPI:1780887687
Name:MARK E. JAWAHIR PA
Entity type:Organization
Organization Name:MARK E. JAWAHIR PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EVANGELIST
Authorized Official - Last Name:JAWAHIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-402-0244
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 1:1763 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:2007-06-07
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64562207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0722AMedicare PIN
6385380001Medicare NSC
FLE12455Medicare UPIN
FLDC5731Medicare PIN