Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ME110119 | FL |
N | 111NI0900X | Internist | ME110119 | FL |
N | 207RC0200X | Critical Care Medicine | ME110119 | FL |
Y | 207RP1001X | Pulmonary Disease | ME110119 | FL |
NPI | 1063746873 |
---|---|
Provider Name | Dr. Mohamed Omar Radwan |
First Address | Jacksonville, FL 32207-8568 |
Second Address | Jacksonville, FL 32207-8568 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2009 |
Last Update Date | 11/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003911100 | (05) | FL |
14H00 | BCBS (01) | FL |
348958 | AVMED (01) | FL |
59-3385828 | TAX ID FOR OTHER INSURANCES (01) | FL |
936658 | AETNA (01) | FL |
P01364661 | MEDICARE RAILROAD (01) | FL |