Provider Demographics
NPI:1396825105
Name:MASRI, NIDAL (MD)
Entity Type:Individual
Prefix:DR
First Name:NIDAL
Middle Name:
Last Name:MASRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:MASRI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1100 SW 57TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-5129
Mailing Address - Country:US
Mailing Address - Phone:305-262-6484
Mailing Address - Fax:305-263-6370
Practice Address - Street 1:1100 SW 57TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-5129
Practice Address - Country:US
Practice Address - Phone:305-262-6484
Practice Address - Fax:305-865-1314
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72054208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH50551Medicare UPIN