Provider Demographics
NPI:1114034709
Name:FARHAT, JAWAD SAMIR (MD)
Entity type:Individual
Prefix:MR
First Name:JAWAD
Middle Name:SAMIR
Last Name:FARHAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 PLANTATION ISLAND DR S STE 9
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-3106
Mailing Address - Country:US
Mailing Address - Phone:904-460-9191
Mailing Address - Fax:904-471-4859
Practice Address - Street 1:1000 PLANTATION ISLAND DR S STE 9
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-3106
Practice Address - Country:US
Practice Address - Phone:904-460-9191
Practice Address - Fax:904-471-4859
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74226208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256431900Medicaid
G86156Medicare UPIN