Provider Demographics
NPI:1972000461
Name:SAMARRAI, SAM ALEXANDER (MD)
Entity Type:Individual
Prefix:MR
First Name:SAM
Middle Name:ALEXANDER
Last Name:SAMARRAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:SAM
Other - Middle Name:HUSSAM SADIO
Other - Last Name:AL-SAMRRAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1839 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8900
Mailing Address - Country:US
Mailing Address - Phone:727-820-1040
Mailing Address - Fax:727-821-7213
Practice Address - Street 1:8133 54TH AVE N.
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-8900
Practice Address - Country:US
Practice Address - Phone:727-541-4458
Practice Address - Fax:727-546-6663
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME152025207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLYDQK6OtherFLORIDA BLUE
FL111404100Medicaid