Provider Demographics
NPI:1811963234
Name:ARRAY, SAMIR YAMIL (MD)
Entity type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:YAMIL
Last Name:ARRAY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8274 BAYBERRY RD
Practice Address - Street 2:UFJP BAYMEADOWS PEDIATRICS
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7470
Practice Address - Country:US
Practice Address - Phone:904-633-0800
Practice Address - Fax:904-633-0381
Is Sole Proprietor?:No
Enumeration Date:2006-02-25
Last Update Date:2008-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME62946207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF73019Medicare UPIN
FL23742XMedicare PIN
FL80084557Medicare PIN