Provider Demographics
NPI:1508975566
Name:BARRETO-SAMALOT, HECTOR DELFIN (MD)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:DELFIN
Last Name:BARRETO-SAMALOT
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 1:2205 E MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-4944
Mailing Address - Country:US
Mailing Address - Phone:407-895-6846
Mailing Address - Fax:407-895-6847
Practice Address - Street 1:2205 E MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4944
Practice Address - Country:US
Practice Address - Phone:407-895-6846
Practice Address - Fax:407-895-6847
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65145207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E57717Medicare UPIN
FL26879YMedicare ID - Type Unspecified