Provider Demographics
NPI:1518451137
Name:TWEDT, SAMUEL ANTON (DO)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ANTON
Last Name:TWEDT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1110 BROAD AVE
Mailing Address - Street 2:STE 700
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-8908
Mailing Address - Country:US
Mailing Address - Phone:228-864-0314
Mailing Address - Fax:228-868-0425
Practice Address - Street 1:1665 S GREEN ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-6556
Practice Address - Country:US
Practice Address - Phone:662-377-2189
Practice Address - Fax:662-377-2667
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2021-08-20
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Provider Licenses
StateLicense IDTaxonomies
MS27364207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine