Provider Demographics
NPI:1932477023
Name:SAMIR M. EBEID
Entity Type:Organization
Organization Name:SAMIR M. EBEID
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:MASAN
Authorized Official - Last Name:EBEID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-785-0321
Mailing Address - Street 1:2202 STATE AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405
Mailing Address - Country:US
Mailing Address - Phone:850-785-0321
Mailing Address - Fax:850-784-9955
Practice Address - Street 1:2202 STATE AVE STE 302
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405
Practice Address - Country:US
Practice Address - Phone:850-785-0321
Practice Address - Fax:850-784-9955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046120208000000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL040815800Medicaid