Provider Demographics
NPI:1871692384
Name:SAMUEL, MARITZA E (MD)
Entity type:Individual
Prefix:
First Name:MARITZA
Middle Name:E
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 SOUTH MAIN ST
Mailing Address - Street 2:SUITE 131
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-3473
Mailing Address - Country:US
Mailing Address - Phone:561-996-3933
Mailing Address - Fax:561-996-3908
Practice Address - Street 1:141 SOUTH MAIN ST
Practice Address - Street 2:SUITE 131
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-3473
Practice Address - Country:US
Practice Address - Phone:561-996-3933
Practice Address - Fax:561-996-3908
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50474208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11319Medicare ID - Type Unspecified
E66532Medicare UPIN