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Individual
SAMAR FAWAZ
Active
Individual
SAMAR FAWAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
5601008292
MI
363A00000X
Physician Assistant
Primary
PA9111341
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101048700
—
FL
01
—
JL436Z
MEDICARE PTAN
FL
01
—
P02091188
RRMEDICARE PTAN
FL
Enumeration date
09/21/2017
Last updated
10/31/2018
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