Provider Demographics
NPI:1891709424
Name:ALEXANDER, SAMUEL M (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:M
Last Name:ALEXANDER
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 1:4720 S. I-10 SERVICE RD.
Mailing Address - Street 2:SUITE 400
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001
Mailing Address - Country:US
Mailing Address - Phone:504-455-1107
Mailing Address - Fax:504-887-9167
Practice Address - Street 1:4720 S. I-10 SERVICE RD.
Practice Address - Street 2:SUITE 400
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001
Practice Address - Country:US
Practice Address - Phone:504-455-1107
Practice Address - Fax:504-887-9167
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD020536207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA19738OtherSTATE NARCOTICS
LAMD020536OtherSTATE MEDICAL LICENSE
LA1973190Medicaid
LAMD020536OtherSTATE MEDICAL LICENSE
LAF56944Medicare UPIN