Provider Demographics
NPI:1881657658
Name:SERAG, SHERIF M (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERIF
Middle Name:M
Last Name:SERAG
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 1:1152 62ND AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-5620
Mailing Address - Country:US
Mailing Address - Phone:727-866-6306
Mailing Address - Fax:727-864-9614
Practice Address - Street 1:1152 62ND AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-5620
Practice Address - Country:US
Practice Address - Phone:727-866-6306
Practice Address - Fax:727-864-9614
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76807207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254945000Medicaid
FL593534929OtherTAX ID #
FL593534929OtherTAX ID #
G77606Medicare UPIN