Provider Demographics
NPI:1811691496
Name:SAMHOUN, JALAL WAFIC JR (MD)
Entity type:Individual
Prefix:
First Name:JALAL
Middle Name:WAFIC
Last Name:SAMHOUN
Suffix:JR
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 1:551 SANTA CLARA TRL
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3921
Mailing Address - Country:US
Mailing Address - Phone:561-601-8944
Mailing Address - Fax:
Practice Address - Street 1:800 MEADOWS RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2304
Practice Address - Country:US
Practice Address - Phone:561-297-4828
Practice Address - Fax:561-955-3577
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program