Provider Demographics
NPI:1528011889
Name:CHAN, SAMUEL N (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:N
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10000 BAY PINES BLVD
Mailing Address - Street 2:BLDG. 100, 4C-100
Mailing Address - City:BAY PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33744
Mailing Address - Country:US
Mailing Address - Phone:727-398-6661
Mailing Address - Fax:727-319-1276
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-2505
Practice Address - Fax:706-721-1500
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2016-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA046944207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF78554Medicare UPIN