Provider Demographics
NPI:1811930092
Name:HAWATMEH, ISAM S (M D)
Entity type:Individual
Prefix:DR
First Name:ISAM
Middle Name:S
Last Name:HAWATMEH
Suffix:
Gender:M
Credentials:M D
Other - Prefix:DR
Other - First Name:SAM
Other - Middle Name:S
Other - Last Name:HAWATMEH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:M D
Mailing Address - Street 1:12345 W BEND DR STE 304
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2256
Mailing Address - Country:US
Mailing Address - Phone:314-722-2500
Mailing Address - Fax:314-722-2556
Practice Address - Street 1:12345 W BEND DR STE 304
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2256
Practice Address - Country:US
Practice Address - Phone:314-722-2500
Practice Address - Fax:314-645-8244
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7D78207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1110163355OtherRRMCR
MO20315OtherHEALTHCARE
MO26810OtherBLUE CROSS
MO1140267OtherCARE PARTNER
MOPC23505OtherCIGNA
MO125694OtherHEALTHLINK
MO178V178OtherGHP
MO305572OtherPARTNER HMO
MO889041OtherCOMMUNITY
MOSTL040029OtherUNITED HEALTHCARE
MO178V178OtherCMR
MOSTM040053OtherMED COMP
MO1125337OtherFIRST HORIZON
MO1811930092OtherANY INSURANCES
MO202132114Medicaid
MO26810OtherBLUE CHOICE
MO431540492OtherCOMMERICAL
MO431540492OtherCOMMERICAL