Provider Demographics
NPI:1659395234
Name:CLEVELAND, SAMUEL M (DO)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:M
Last Name:CLEVELAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ROYAL CT
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-5131
Mailing Address - Country:US
Mailing Address - Phone:727-712-1339
Mailing Address - Fax:727-712-9615
Practice Address - Street 1:323 JEFFORDS ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3825
Practice Address - Country:US
Practice Address - Phone:727-298-6277
Practice Address - Fax:727-447-7175
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL3907207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL57481OtherBLUE SHIELD
FLP00058055OtherRAILROAD MEDICARE
FL57481VMedicare ID - Type Unspecified
FL57481OtherBLUE SHIELD