Provider Demographics
NPI:1548219751
Name:SOUBRA, SAID HASSANE (MD)
Entity Type:Individual
Prefix:DR
First Name:SAID
Middle Name:HASSANE
Last Name:SOUBRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 LA CALMA DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-3843
Mailing Address - Country:US
Mailing Address - Phone:512-986-7765
Mailing Address - Fax:512-986-7768
Practice Address - Street 1:1464 E WHITESTONE BLVD
Practice Address - Street 2:SUITE 601
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-9058
Practice Address - Country:US
Practice Address - Phone:512-986-7765
Practice Address - Fax:512-986-7608
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7568207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163665604Medicaid
TX136665601Medicaid
TX8F7529Medicare PIN
TX163665604Medicaid
TX8F8021Medicare PIN
TXP00602923Medicare PIN
TX8F8711Medicare PIN
TX136665601Medicaid
TX8B4319Medicare PIN