Provider Demographics
NPI:1932270501
Name:SAMUEL AND PHILOGENE PA
Entity type:Organization
Organization Name:SAMUEL AND PHILOGENE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLAIX
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILOGENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-996-3933
Mailing Address - Street 1:141 S 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 S 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50445207R00000X
FLME50474208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty