Provider Demographics
NPI:1235215062
Name:KOUSSAYER, SAMER (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMER
Middle Name:
Last Name:KOUSSAYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 SOUTH PARSONS AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511
Mailing Address - Country:US
Mailing Address - Phone:813-681-4644
Mailing Address - Fax:813-654-4486
Practice Address - Street 1:325 SOUTH PARSONS AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:813-681-4644
Practice Address - Fax:813-654-4486
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0074361208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
9606443OtherGHI
47284OtherBLUECROSS/BLUESHIELD
01111OtherUNIVERSAL
FL264790700Medicaid
TX104574203Medicaid
3751735001OtherCIGNA HMO
7138025OtherAETNA
218058OtherAMERIGROUP
261352OtherAVMED
770002304OtherR.R.MEDICARE
G29812Medicare UPIN