Provider Demographics
NPI:1689657223
Name:SAMUELS, ALAN DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:DANIEL
Last Name:SAMUELS
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 1:1324 WOLF PARK DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1741
Mailing Address - Country:US
Mailing Address - Phone:901-755-9110
Mailing Address - Fax:901-755-4321
Practice Address - Street 1:1324 WOLF PARK DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1741
Practice Address - Country:US
Practice Address - Phone:901-755-9110
Practice Address - Fax:901-755-4321
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD008082207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB02446Medicare UPIN
TN3153179Medicare ID - Type Unspecified