Provider Demographics
NPI:1639432156
Name:ELIAS-AUSI, SAMUEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:S
Last Name:ELIAS-AUSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SAMI
Other - Middle Name:
Other - Last Name:ASSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8828 HAMPTON LANDING DR E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4581
Mailing Address - Country:US
Mailing Address - Phone:412-925-9387
Mailing Address - Fax:
Practice Address - Street 1:5900 LAKE ELLENOR DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4618
Practice Address - Country:US
Practice Address - Phone:407-352-6968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA082041207Q00000X, 207QA0505X
FLME129836207Q00000X
PAMD455198207Q00000X
FLME129638207QA0505X
DEC1-0012156208M00000X
ORMD204788207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103034936Medicaid
FL019563600Medicaid