Provider Demographics
NPI:1437208998
Name:NABIL BARSOUM MD PA
Entity Type:Organization
Organization Name:NABIL BARSOUM MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARSOUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-426-9600
Mailing Address - Street 1:100 S MILITARY TRAIL
Mailing Address - Street 2:SUITE 10
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442
Mailing Address - Country:US
Mailing Address - Phone:954-426-9600
Mailing Address - Fax:954-426-2257
Practice Address - Street 1:100 S MILITARY TRAIL
Practice Address - Street 2:SUITE 10
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442
Practice Address - Country:US
Practice Address - Phone:954-426-9600
Practice Address - Fax:954-426-2257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0047714207QA0505X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048800399Medicaid
FLD21229Medicare UPIN
FL6028810001Medicare NSC
FL048800399Medicaid