Individual
DR. MOHAMED OMAR RADWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1325 SAN MARCO BLVD, REID BUILDING, STE 300, JACKSONVILLE, FL 32207-8568
(904) 253-6910
(904) 253-6964
Mailing address
1325 SAN MARCO BLVD, REID BUILDING, STE 300, JACKSONVILLE, FL 32207-8568
(904) 253-6910
(904) 253-6964
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME110119
FL
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
ME110119
FL
207RP1001X
Pulmonary Disease Physician
Primary
ME110119
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003911100
—
FL
01
—
14H00
BCBS
FL
01
—
348958
AVMED
FL
01
—
59-3385828
TAX ID FOR OTHER INSURANCES
FL
01
—
936658
AETNA
FL
01
—
P01364661
MEDICARE RAILROAD
FL
Enumeration date
09/25/2009
Last updated
04/11/2017
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