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General NPI Number Information
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NPI Number | 1376518399
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Entity Type | Individual
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Provider Name | HAZEM MAHMOUD SAMY MD
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Gender | Male
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 04/19/2019
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Provider Practice Location Address
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Address Line | 13241 BARTRAM PARK BLVD UNIT 1505
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City | JACKSONVILLE
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State | FL
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Zip | 32258-5231
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Country | US
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Telephone | 904-374-6899
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Fax | 904-503-0039
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Provider Business Mailing Address
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Address Line | 13241 BARTRAM PARK BLVD UNIT 1505
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City | JACKSONVILLE
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State | FL
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Zip | 32258-5231
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME105047
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207WX0009X
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Taxonomy Name | Glaucoma Specialist (Ophthalmology) Physician
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License Number | ME105047
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD426523
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 207WX0109X
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Taxonomy Name | Neuro-ophthalmology Physician
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License Number | ME105047
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License Number State | FL
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