Provider Demographics
NPI:1386994366
Name:IHMUD, SAMIR MOHAMMAD (IDC)
Entity type:Individual
Prefix:
First Name:SAMIR
Middle Name:MOHAMMAD
Last Name:IHMUD
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3D MED BN, 3D MLG
Mailing Address - Street 2:UNIT 38447
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96604-8447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3D MED BN, 3D MLG
Practice Address - Street 2:UNIT 38447
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96604-8447
Practice Address - Country:US
Practice Address - Phone:098-970-7372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman