Provider Demographics
NPI:1760413249
Name:BUDNYK, SAMUEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:A
Last Name:BUDNYK
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 1:1225 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2909
Mailing Address - Country:US
Mailing Address - Phone:850-650-7606
Mailing Address - Fax:850-337-1698
Practice Address - Street 1:1225 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2909
Practice Address - Country:US
Practice Address - Phone:850-650-7606
Practice Address - Fax:850-337-1698
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61503174400000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376054500Medicaid
FL25454OtherBCBS
FL25454AMedicare ID - Type UnspecifiedMEDICARE #
FL376054500Medicaid