Provider Demographics
NPI:1396880043
Name:SAMUELS, JEFFREY ALLAN (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALLAN
Last Name:SAMUELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:ALLAN
Other - Last Name:SAMUELS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD,PA
Mailing Address - Street 1:1 W SAMPLE RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-3547
Mailing Address - Country:US
Mailing Address - Phone:954-941-5355
Mailing Address - Fax:954-941-5675
Practice Address - Street 1:1 W SAMPLE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-3547
Practice Address - Country:US
Practice Address - Phone:954-941-5355
Practice Address - Fax:954-941-5675
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60132208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL053956200Medicaid
FL1396880043OtherNPI NUMBER
FLA39581Medicare UPIN
FL053956200Medicaid