MEDICARE: SAMIR DOUIDAR M.D.

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	174400000X	Specialist	ME65878	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
2	B905P	OTHER	FL	BCBSFL

General Provider Information

NPI Number	:	1902850514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMIR DOUIDAR M.D.

Provider Business Mailing Address
First Line	:	10359 CROSS CREEK BLVD STE CD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-2772
Country	:	US
Telephone Number	:	813-994-0044
Fax Number	:	813-994-0055

Provider Business Practice Location Address
First Line	:	10359 CROSS CREEK BLVD STE CD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-2772
Country	:	US
Telephone Number	:	813-994-0044
Fax Number	:	813-994-0055

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	08/04/2021

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Directions to “ SAMIR DOUIDAR M.D.” Practice Location

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