Provider Demographics
NPI:1467428177
Name:SAMUEL, VINCENT K (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:K
Last Name:SAMUEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6060 POPLAR AVE
Mailing Address - Street 2:SUITE 364
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3980
Mailing Address - Country:US
Mailing Address - Phone:901-818-2162
Mailing Address - Fax:901-818-2163
Practice Address - Street 1:6060 POPLAR AVE
Practice Address - Street 2:SUITE 364
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3980
Practice Address - Country:US
Practice Address - Phone:901-818-2162
Practice Address - Fax:901-818-2163
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD27856207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3800784Medicaid
MS00122566Medicaid
MO209768415Medicaid
AR146439001Medicaid
TN3800785Medicare PIN
TNG27569Medicare UPIN