Provider Demographics
NPI:1346261377
Name:ESTEPA, SAMUEL VILORIA (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:VILORIA
Last Name:ESTEPA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 E MARION AVE
Mailing Address - Street 2:STE 141
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-3863
Mailing Address - Country:US
Mailing Address - Phone:941-205-3200
Mailing Address - Fax:941-639-7576
Practice Address - Street 1:713 E MARION AVE
Practice Address - Street 2:STE 141
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3863
Practice Address - Country:US
Practice Address - Phone:941-205-3200
Practice Address - Fax:941-639-7576
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0049989207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0472239-00Medicaid
FL0472239-00Medicaid
FLD20843Medicare UPIN