Provider Demographics
NPI:1316535487
Name:CUIDON, SAMUEL WADE (IDMT)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:WADE
Last Name:CUIDON
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2630 CENTRAL AVE # 3349
Mailing Address - Street 2:
Mailing Address - City:EIELSON AFB
Mailing Address - State:AK
Mailing Address - Zip Code:99702-2301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2630 CENTRAL AVE # 3349
Practice Address - Street 2:
Practice Address - City:EIELSON AFB
Practice Address - State:AK
Practice Address - Zip Code:99702-2301
Practice Address - Country:US
Practice Address - Phone:405-582-6048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2022-07-12
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians