MEDICARE: DR. SAMIR DRAA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	ME133587	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376662387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMIR DRAA M.D.

Provider Business Mailing Address
First Line	:	3103 INNOVATION DR
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-6501
Country	:	US
Telephone Number	:	860-992-6794
Fax Number	:	407-249-1755

Provider Business Practice Location Address
First Line	:	3103 INNOVATION DR
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-6501
Country	:	US
Telephone Number	:	860-992-6794
Fax Number	:	407-249-1755

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	10/08/2021

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