Basic Information
Provider Information
NPI: 1720215122
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MASRI
FirstName: HADY
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3200 S UNIVERSITY DR
Address2:  
City: DAVIE
State: FL
PostalCode: 333282018
CountryCode: US
TelephoneNumber: 9542624100
FaxNumber: 9542623285
Practice Location
Address1: 3200 S UNIVERSITY DR
Address2:  
City: DAVIE
State: FL
PostalCode: 333282018
CountryCode: US
TelephoneNumber: 9542624100
FaxNumber: 9542623285
Other Information
ProviderEnumerationDate: 06/12/2009
LastUpdateDate: 10/29/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207QG0300XOS10363FLY Allopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine

No ID Information.


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