Provider Demographics
NPI:1033207741
Name:SAMUEL, ROGER Z (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:Z
Last Name:SAMUEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 CAMINO REAL STE 401
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5510
Mailing Address - Country:US
Mailing Address - Phone:561-368-8998
Mailing Address - Fax:561-392-9170
Practice Address - Street 1:7100 CAMINO REAL STE 401
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5510
Practice Address - Country:US
Practice Address - Phone:561-368-8998
Practice Address - Fax:561-392-9170
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ06602084P0800X
FLME00590662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14560ZOtherPROVIDER
FL14560ZOtherPROVIDER #
FL14560ZOtherPROVIDER #
FLE88407Medicare UPIN
E88407Medicare UPIN