Provider Demographics
NPI:1316918246
Name:BLICK, SAMUEL SMITH (MD)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:SMITH
Last Name:BLICK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:25 WEST CRYSTAL LAKE STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-9918
Mailing Address - Country:US
Mailing Address - Phone:407-254-2500
Mailing Address - Fax:407-423-9512
Practice Address - Street 1:25 W CRYSTAL LAKE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4475
Practice Address - Country:US
Practice Address - Phone:407-254-2500
Practice Address - Fax:407-423-9512
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2016-01-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0062664207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3T1121800Medicaid
FL3T1121800Medicaid
D76710Medicare UPIN