Provider Demographics
NPI:1740744663
Name:SAOL MD LLC
Entity Type:Organization
Organization Name:SAOL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:EDSON
Authorized Official - Last Name:BELCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-244-1857
Mailing Address - Street 1:9860 S THOMAS DR UNIT 1809
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32408-1285
Mailing Address - Country:US
Mailing Address - Phone:516-244-1857
Mailing Address - Fax:
Practice Address - Street 1:3212 JENKS AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4224
Practice Address - Country:US
Practice Address - Phone:516-244-1857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty