Provider Demographics
NPI:1992761894
Name:SMALL, SAMUEL D (DO)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:D
Last Name:SMALL
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:168 N BRENT ST
Mailing Address - Street 2:505
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2817
Mailing Address - Country:US
Mailing Address - Phone:805-648-3902
Mailing Address - Fax:805-648-4014
Practice Address - Street 1:168 N BRENT ST
Practice Address - Street 2:505
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2817
Practice Address - Country:US
Practice Address - Phone:805-648-3902
Practice Address - Fax:805-648-4014
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2012-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A4466207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGT358ZMedicare PIN
CA0878110001Medicare NSC