Provider Demographics
NPI:1013941939
Name:SAMUEL, ERIC B (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:B
Last Name:SAMUEL
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 1:3840 COCONUT CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-1617
Mailing Address - Country:US
Mailing Address - Phone:954-580-8867
Mailing Address - Fax:545-808-9679
Practice Address - Street 1:3840 COCONUT CREEK PKWY
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33066-1617
Practice Address - Country:US
Practice Address - Phone:954-580-8867
Practice Address - Fax:954-580-8942
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH16383207Q00000X
MA277277207Q00000X
FL159879207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2610523Medicaid
FL47212VMedicare PIN
FLH05495Medicare UPIN
FLH05495Medicare UPIN