Provider Demographics
NPI:1669430393
Name:FARIS, SAMIR H (MD)
Entity type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:H
Last Name:FARIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-868-5871
Mailing Address - Fax:321-951-7408
Practice Address - Street 1:701 W COCOA BEACH CSWY
Practice Address - Street 2:CCH/HOSPITALIST DEPT
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-3585
Practice Address - Country:US
Practice Address - Phone:321-868-5871
Practice Address - Fax:321-868-5852
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96516207R00000X, 208M00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279990100Medicaid
FLAH690XOtherMEDICARE
FLME96516OtherLICENSE