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General NPI Number Information
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NPI Number | 1568792380
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Entity Type | Organization
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Legal Business Name | SAMIR ELIAS MD PA
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Dates
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Enumeration Date | 12/29/2009
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Last Update Date | 12/29/2009
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Provider Practice Location Address
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Address Line | 1655 JESS PARRISH CT
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City | TITUSVILLE
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State | FL
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Zip | 32796-2104
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Country | US
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Telephone | 321-269-4911
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Fax | 321-383-1368
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Provider Business Mailing Address
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Address Line | 1655 JESS PARRISH CT
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City | TITUSVILLE
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State | FL
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Zip | 32796-2104
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Country | US
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Telephone | 321-269-4911
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Fax | 321-383-1368
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SAMIR ELIAS
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Credential | MD
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Telephone | 321-269-4911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | ME32055
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License Number State | FL
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