Provider Demographics
NPI:1801007646
Name:KSAR, JAMAL SAMIH (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMAL
Middle Name:SAMIH
Last Name:KSAR
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 1:8791 CONFERENCE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-5822
Mailing Address - Country:US
Mailing Address - Phone:239-938-3506
Mailing Address - Fax:
Practice Address - Street 1:8791 CONFERENCE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-5822
Practice Address - Country:US
Practice Address - Phone:239-938-3506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1063422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1490TOtherBCBSFL
FLP00886227OtherRR MEDICARE
FL002442200Medicaid
FLDN148ZMedicare PIN