Provider Demographics
NPI:1659805406
Name:ELBADRI, SAMYR (MD)
Entity Type:Individual
Prefix:
First Name:SAMYR
Middle Name:
Last Name:ELBADRI
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 1:1431 SW 1ST AVE
Mailing Address - Street 2:BITZER BLDG, SUITE 7
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6500
Mailing Address - Country:US
Mailing Address - Phone:352-401-8323
Mailing Address - Fax:352-401-8313
Practice Address - Street 1:1431 SW 1ST AVE
Practice Address - Street 2:BITZER BLDG, SUITE 7
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6500
Practice Address - Country:US
Practice Address - Phone:352-401-8323
Practice Address - Fax:352-401-8313
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME145332207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty