Provider Demographics
NPI:1245214931
Name:MAHMOUD, SAMIR S (MD)
Entity Type:Individual
Prefix:
First Name:SAMIR
Middle Name:S
Last Name:MAHMOUD
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 1:1212 OAK KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-5515
Mailing Address - Country:US
Mailing Address - Phone:925-708-1102
Mailing Address - Fax:
Practice Address - Street 1:1212 OAK KNOLL DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-5515
Practice Address - Country:US
Practice Address - Phone:925-708-1102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35196207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine