Provider Demographics
NPI:1386989010
Name:SCOTT B. SAMERA, DPM, PA, LLC
Entity type:Organization
Organization Name:SCOTT B. SAMERA, DPM, PA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:SAMERA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:386-935-1093
Mailing Address - Street 1:PO BOX 846
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32008-0846
Mailing Address - Country:US
Mailing Address - Phone:386-935-1093
Mailing Address - Fax:
Practice Address - Street 1:404 NW HALL OF FAME DR
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4833
Practice Address - Country:US
Practice Address - Phone:386-935-1093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCOTT B. SAMERA, DPM, PA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3510213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty