Provider Demographics
NPI:1275995177
Name:SAMARA, WASIM (MD)
Entity Type:Individual
Prefix:
First Name:WASIM
Middle Name:
Last Name:SAMARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WASIM
Other - Middle Name:AYED SAED
Other - Last Name:SAMARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2101 HIGHLAND AVE S STE 350
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-4009
Mailing Address - Country:US
Mailing Address - Phone:205-558-2525
Mailing Address - Fax:205-558-2554
Practice Address - Street 1:2208 UNIVERSITY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-2313
Practice Address - Country:US
Practice Address - Phone:205-933-2625
Practice Address - Fax:205-558-2596
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.39373207W00000X, 207WX0107X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist