Provider Demographics
NPI:1518962885
Name:KORLEY, SAM M (MD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:M
Last Name:KORLEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6675 WESTWOOD BLVD
Mailing Address - Street 2:STE 475
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-6027
Mailing Address - Country:US
Mailing Address - Phone:407-845-0330
Mailing Address - Fax:888-972-1752
Practice Address - Street 1:4729 US HIGHWAY 98 S STE 201
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33812-4336
Practice Address - Country:US
Practice Address - Phone:863-646-9663
Practice Address - Fax:863-646-9664
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2023-06-01
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Provider Licenses
StateLicense IDTaxonomies
FLME67759207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379364800Medicaid
FLG27020Medicare UPIN
FL379364800Medicaid