# SAM F WANIS DO PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235375122
- **Authorized official:** DR. SAMEH FAYEZ WANIS D.O. (PHYSICIAN)
- **Authorized official phone:** (561) 969-3500

## Contact information

- **Practice address:** 2925 10TH AVE N, SUITE \#204, LAKE WORTH, FL 33460-3046
- **Practice address phone:** (561) 969-3500
- **Practice address fax:** (561) 966-8898
- **Mailing address:** 2925 10TH AVE N, SUITE \#204, LAKE WORTH, FL 33460-3046
- **Mailing address phone:** (561) 969-3500
- **Mailing address fax:** (561) 966-8898

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | OS7511 | FL | Yes |

## Other

- **Enumeration date:** 12/23/2008
- **Last updated:** 02/04/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 253706100 | — | FL |