Provider Demographics
NPI:1215923396
Name:GURU, SAMIR C (DO)
Entity type:Individual
Prefix:
First Name:SAMIR
Middle Name:C
Last Name:GURU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 BAY RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-2105
Mailing Address - Country:US
Mailing Address - Phone:352-483-5633
Mailing Address - Fax:352-483-5070
Practice Address - Street 1:1945 BAY RD
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-2105
Practice Address - Country:US
Practice Address - Phone:352-483-5633
Practice Address - Fax:352-483-5070
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9328207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDD9204OtherRAILROAD MEDICARE GROUP
FL16714OtherBLUE CROSS BLUE SHIELD FL
FLP00260225OtherRAILROAD MEDICARE GURU
FL16714ZMedicare PIN
FLDD9204OtherRAILROAD MEDICARE GROUP