Provider Demographics
NPI:1134466360
Name:SAMUEL RAND MEDICAL CLINIC P.A.
Entity Type:Organization
Organization Name:SAMUEL RAND MEDICAL CLINIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-966-3300
Mailing Address - Street 1:4480 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3511
Mailing Address - Country:US
Mailing Address - Phone:954-966-3300
Mailing Address - Fax:954-966-3303
Practice Address - Street 1:4480 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3511
Practice Address - Country:US
Practice Address - Phone:954-966-3300
Practice Address - Fax:954-966-3303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME24509207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC66672Medicare UPIN