Provider Demographics
NPI:1902856503
Name:CRITIDES, SAMUEL D JR (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:D
Last Name:CRITIDES
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:350G RACETRACK RD NW
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-1699
Mailing Address - Country:US
Mailing Address - Phone:850-374-3125
Mailing Address - Fax:850-226-5544
Practice Address - Street 1:350G RACETRACK RD NW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1699
Practice Address - Country:US
Practice Address - Phone:850-374-3125
Practice Address - Fax:850-226-5544
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-10-23
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Provider Licenses
StateLicense IDTaxonomies
FLME150323207T00000X
FLME120198207T00000X, 207T00000X
WI53806-20207T00000X
NC9601542207T00000X
GA079468207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery