Provider Demographics
NPI:1376518399
Name:SAMY, HAZEM MAHMOUD (MD)
Entity type:Individual
Prefix:DR
First Name:HAZEM
Middle Name:MAHMOUD
Last Name:SAMY
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 1:13241 BARTRAM PARK BLVD UNIT 1505
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13241 BARTRAM PARK BLVD UNIT 1505
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5231
Practice Address - Country:US
Practice Address - Phone:904-374-6899
Practice Address - Fax:904-503-0039
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105047207W00000X, 207WX0009X, 207WX0109X
PAMD426523174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101294355Medicaid
PAI03761Medicare UPIN
PA091744FFFMedicare ID - Type Unspecified
PA101294355Medicaid