Provider Demographics
NPI:1922288588
Name:SAMUELSON, SCOTT JAMES (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:JAMES
Last Name:SAMUELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1121 E 3900 S
Mailing Address - Street 2:STE C-240
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1214
Mailing Address - Country:US
Mailing Address - Phone:801-266-0878
Mailing Address - Fax:801-266-2074
Practice Address - Street 1:389 S 900 E
Practice Address - Street 2:STE 100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2310
Practice Address - Country:US
Practice Address - Phone:385-282-2125
Practice Address - Fax:385-282-2126
Is Sole Proprietor?:No
Enumeration Date:2007-11-11
Last Update Date:2016-10-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT5918534-1205207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107065766102OtherSELECT HEALTH
UT107065766102OtherSELECT HEALTH
UT000067058Medicare PIN