Provider Demographics
NPI:1396717278
Name:BARSOUM, NABIL ATTALLA (MD)
Entity type:Individual
Prefix:DR
First Name:NABIL
Middle Name:ATTALLA
Last Name:BARSOUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 S MILITARY TRAIL
Mailing Address - Street 2:SUITE 10
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-3015
Mailing Address - Country:US
Mailing Address - Phone:954-426-9600
Mailing Address - Fax:954-426-2257
Practice Address - Street 1:100 S MILITARY TRAIL
Practice Address - Street 2:SUITE 10
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-3015
Practice Address - Country:US
Practice Address - Phone:954-426-9600
Practice Address - Fax:954-426-2257
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47714207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048800399Medicaid
FLD21229Medicare UPIN
FL07493XMedicare PIN