Provider Demographics
NPI:1962424531
Name:AWWAD, ABRAHAM I (DO)
Entity type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:I
Last Name:AWWAD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3622 CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711
Mailing Address - Country:US
Mailing Address - Phone:727-322-0245
Mailing Address - Fax:727-323-0994
Practice Address - Street 1:3622 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711
Practice Address - Country:US
Practice Address - Phone:727-322-0245
Practice Address - Fax:727-323-0994
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7025207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G80154Medicare UPIN
43775Medicare ID - Type Unspecified
FL43775YMedicare PIN