MEDICARE: KARIM JACOB SAMARA MD

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	207P00000X	Emergency Medicine Physician	ME91598	FL
2	207R00000X	Internal Medicine Physician	ME91598	FL
3	207W00000X	Ophthalmology Physician	ME91598	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	:	1700844420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARIM JACOB SAMARA MD

Provider Business Mailing Address
First Line	:	3316 3RD ST S
Second Line	:	SUITE 103
City	:	JACKSONVILLE
State	:	FL
Zip	:	32250-6073
Country	:	US
Telephone Number	:	904-241-7865
Fax Number	:

Provider Business Practice Location Address
First Line	:	3316 3RD ST S
Second Line	:	SUITE 103
City	:	JACKSONVILLE
State	:	FL
Zip	:	32250-6073
Country	:	US
Telephone Number	:	904-241-7865
Fax Number	:

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

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	03/17/2014

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