Healthcare Provider Details

I. General information

NPI: 1376662387
Provider Name (Legal Business Name): SAMIR DRAA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3103 INNOVATION DR
SAINT CLOUD FL
34769-6501
US

IV. Provider business mailing address

3103 INNOVATION DR
SAINT CLOUD FL
34769-6501
US

V. Phone/Fax

Practice location:
  • Phone: 860-992-6794
  • Fax: 407-249-1755
Mailing address:
  • Phone: 860-992-6794
  • Fax: 407-249-1755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME133587
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: