Provider Demographics
NPI:1114903184
Name:SAMALOT, JOSE MIGUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MIGUEL
Last Name:SAMALOT
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:PO BOX 1131
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1131
Mailing Address - Country:US
Mailing Address - Phone:787-854-7380
Mailing Address - Fax:787-854-7380
Practice Address - Street 1:PLAZA KAROMA
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-5956
Practice Address - Country:US
Practice Address - Phone:787-854-7380
Practice Address - Fax:787-854-7380
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7289208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2991OtherINTERNATIONAL MEDICAL CAR
PR99361SAOtherTRIPLE-S