Provider Demographics
NPI:1205936770
Name:WASSEF, YOUSSEF W (MD, MS)
Entity type:Individual
Prefix:DR
First Name:YOUSSEF
Middle Name:W
Last Name:WASSEF
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 358492
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32635-8492
Mailing Address - Country:US
Mailing Address - Phone:352-367-3422
Mailing Address - Fax:352-379-7707
Practice Address - Street 1:6801 NW 9TH BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4269
Practice Address - Country:US
Practice Address - Phone:352-367-3422
Practice Address - Fax:352-379-7707
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 00704902081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51651OtherBLUE CROSS BLUE SHIELD ID
FL51651ZMedicaid
FL267792000Medicaid
FL51651OtherBLUE CROSS BLUE SHIELD ID
G 30381Medicare UPIN