Provider Demographics
NPI:1871695429
Name:EBEID, SAMIR HASAN (MD)
Entity type:Individual
Prefix:MR
First Name:SAMIR
Middle Name:HASAN
Last Name:EBEID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2202 STATE AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405
Mailing Address - Country:US
Mailing Address - Phone:850-785-0321
Mailing Address - Fax:850-784-9955
Practice Address - Street 1:2202 STATE AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405
Practice Address - Country:US
Practice Address - Phone:850-785-0321
Practice Address - Fax:850-784-9955
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0046120208000000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL040815800Medicaid
FL03625OtherBCBS
FL040815800Medicaid