Provider Demographics
NPI:1851335327
Name:MASRI, ADDAM (MD)
Entity Type:Individual
Prefix:
First Name:ADDAM
Middle Name:
Last Name:MASRI
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 1:300 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4246
Mailing Address - Country:US
Mailing Address - Phone:407-900-2747
Mailing Address - Fax:407-264-8388
Practice Address - Street 1:300 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4246
Practice Address - Country:US
Practice Address - Phone:407-900-2747
Practice Address - Fax:407-264-8388
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60352207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14933OtherBCBS
FL370121201Medicaid
FL370121201Medicaid
F25176Medicare UPIN
FL14933AMedicare PIN