Provider Demographics
NPI:1548224066
Name:SAMOS, LUIS F (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:F
Last Name:SAMOS
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 1:1201 NW 16TH ST
Mailing Address - Street 2:GERIATRICS AND EXTENDED CARE
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-1624
Mailing Address - Country:US
Mailing Address - Phone:305-575-3559
Mailing Address - Fax:305-575-7515
Practice Address - Street 1:1201 NW 16TH ST
Practice Address - Street 2:GERIATRICS AND EXTENDED CARE
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1624
Practice Address - Country:US
Practice Address - Phone:305-575-3559
Practice Address - Fax:305-575-7515
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME59429207RG0300X, 207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0552747-00Medicaid
FL0552747-00Medicaid
FL12869Medicare ID - Type Unspecified