Provider Demographics
NPI:1497710545
Name:AHMAD, SAMIR ABED (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:ABED
Last Name:AHMAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27800 MEDICAL CENTER RD STE 109
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6410
Mailing Address - Country:US
Mailing Address - Phone:915-383-0590
Mailing Address - Fax:949-221-3537
Practice Address - Street 1:27800 MEDICAL CENTER RD STE 109
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6410
Practice Address - Country:US
Practice Address - Phone:915-383-0590
Practice Address - Fax:949-221-3537
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME146737207R00000X
TXK9475207RG0300X
CAA81614207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH24962Medicare UPIN