Provider Demographics
NPI:1306864590
Name:SAMUELS, JOSEPH ERICK (DOM)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ERICK
Last Name:SAMUELS
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2639 W NORVELL BRYANT HWY
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-9440
Mailing Address - Country:US
Mailing Address - Phone:352-746-5669
Mailing Address - Fax:352-746-5795
Practice Address - Street 1:2639 W NORVELL BRYANT HWY
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-9440
Practice Address - Country:US
Practice Address - Phone:352-746-5669
Practice Address - Fax:352-746-5795
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 1286171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC7567OtherBC/BS OF FLORIDA PROVIDER
FLC0620OtherBC/BS OF FLORIDA PROVIDER
FLC0620OtherBC/BS OF FLORIDA PROVIDER