Provider Demographics
NPI:1275020463
Name:RAHMAN, SAMIR
Entity Type:Individual
Prefix:
First Name:SAMIR
Middle Name:
Last Name:RAHMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 W HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4720
Mailing Address - Country:US
Mailing Address - Phone:364-635-2706
Mailing Address - Fax:
Practice Address - Street 1:104 S PINE AVE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452
Practice Address - Country:US
Practice Address - Phone:352-726-3646
Practice Address - Fax:352-726-0079
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPENDING208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery