Provider Demographics
NPI:1477518082
Name:SAMOWITZ, HARVEY R (MD)
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:R
Last Name:SAMOWITZ
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:2500 E HALLANDALE BEACH BLVD STE PH2
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4834
Practice Address - Country:US
Practice Address - Phone:754-707-5680
Practice Address - Fax:754-707-5690
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62933174400000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1193461OtherWELLCARE
FLP0003167OtherFLORIDA HEALTHCARE PLUS
FLP00721041OtherRR MEDICARE
FL31732OtherBCBS FL
FLQMP000003804777OtherMOLINA
FL275077500Medicaid
FLP01720308OtherSIMPLY HEALTHCARE
FL4241514OtherAETNA PROVIDER #
FLQMP000003804777OtherMOLINA
FLP01720308OtherSIMPLY HEALTHCARE
FL4241514OtherAETNA PROVIDER #
FLE90973Medicare UPIN
FL018283400Medicare PIN