Provider Demographics
NPI:1447264817
Name:SAMUELS, DAVID J (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:SAMUELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N ASHLEY DR
Mailing Address - Street 2:SUITE 1625
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-4300
Mailing Address - Country:US
Mailing Address - Phone:813-514-6387
Mailing Address - Fax:813-844-4972
Practice Address - Street 1:1 TAMPA GENERAL CIR
Practice Address - Street 2:SUITE A327
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3571
Practice Address - Country:US
Practice Address - Phone:813-844-4434
Practice Address - Fax:813-844-4972
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54705207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063545600Medicaid
FL10475OtherBLUE CROSS
FL10475VMedicare PIN
FL10475OtherBLUE CROSS
FL10475UMedicare PIN
FL063545600Medicaid