Provider Demographics
NPI:1982728929
Name:STONE SURGERY CLINIC
Entity Type:Organization
Organization Name:STONE SURGERY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FAWZI
Authorized Official - Middle Name:
Authorized Official - Last Name:FAWAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-951-8800
Mailing Address - Street 1:962 US HWY 331 SOUTH
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32435
Mailing Address - Country:US
Mailing Address - Phone:950-951-8800
Mailing Address - Fax:950-951-0203
Practice Address - Street 1:962 US 331 SOUTH
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32435
Practice Address - Country:US
Practice Address - Phone:950-951-8800
Practice Address - Fax:950-951-0203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL82523208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261312300Medicaid
FL1932283389OtherNPI FOR SS#
51318Medicare PIN
FL1932283389OtherNPI FOR SS#
E64631Medicare UPIN