Provider Demographics
NPI:1730412586
Name:ELBA E. MASID, MD, LLC
Entity type:Organization
Organization Name:ELBA E. MASID, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELBA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MASID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-498-0461
Mailing Address - Street 1:4513 OLD CANOE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-1551
Mailing Address - Country:US
Mailing Address - Phone:407-498-0461
Mailing Address - Fax:407-891-1353
Practice Address - Street 1:4513 OLD CANOE CREEK RD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-1551
Practice Address - Country:US
Practice Address - Phone:407-498-0461
Practice Address - Fax:407-891-1353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-11
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102282207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBT531ZMedicare PIN