Provider Demographics
NPI:1902850514
Name:DOUIDAR, SAMIR (MD)
Entity Type:Individual
Prefix:
First Name:SAMIR
Middle Name:
Last Name:DOUIDAR
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 1:10359 CROSS CREEK BLVD STE CD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2772
Mailing Address - Country:US
Mailing Address - Phone:813-994-0044
Mailing Address - Fax:813-994-0055
Practice Address - Street 1:10359 CROSS CREEK BLVD STE CD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2772
Practice Address - Country:US
Practice Address - Phone:813-994-0044
Practice Address - Fax:813-994-0055
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65878174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375833800Medicaid
FLB905POtherBCBSFL