Provider Demographics
NPI:1255330288
Name:SAMOTIN, MYLES RUBIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MYLES
Middle Name:RUBIN
Last Name:SAMOTIN
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 1:870 111TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-1869
Mailing Address - Country:US
Mailing Address - Phone:239-514-4200
Mailing Address - Fax:239-514-3373
Practice Address - Street 1:870 111TH AVE N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-1869
Practice Address - Country:US
Practice Address - Phone:239-514-4200
Practice Address - Fax:239-514-3373
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2012-08-10
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
FLME0072517207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32894ZMedicare PIN
FL1233350001Medicare NSC
FLG50737Medicare UPIN