Healthcare Provider Details

I. General information

NPI: 1235592106
Provider Name (Legal Business Name): SAMER OBID
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

2007 PALM BEACH LAKES BLVD
WEST PALM BEACH FL
33409-6501
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-5215
  • Fax:
Mailing address:
  • Phone: 561-420-8555
  • Fax: 561-420-8550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number140597
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: