Provider Demographics
NPI:1629082607
Name:EDDIN, HUSAM (MD)
Entity Type:Individual
Prefix:DR
First Name:HUSAM
Middle Name:
Last Name:EDDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HUSAM EDDIN
Other - Middle Name:
Other - Last Name:SAAD EDDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1630 MASON AVE STE C
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-4547
Mailing Address - Country:US
Mailing Address - Phone:386-238-9064
Mailing Address - Fax:386-238-9063
Practice Address - Street 1:1630 MASON AVE STE C
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-4547
Practice Address - Country:US
Practice Address - Phone:386-238-9064
Practice Address - Fax:386-238-9063
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94169207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273953400Medicaid
30247 ZMedicare PIN