Provider Demographics
NPI:1801096987
Name:ADU-LARTEY, SAMUEL M (DO)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:M
Last Name:ADU-LARTEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:705 S FRY RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2251
Mailing Address - Country:US
Mailing Address - Phone:832-321-4076
Mailing Address - Fax:832-321-4080
Practice Address - Street 1:705 S FRY RD
Practice Address - Street 2:SUITE 215
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2251
Practice Address - Country:US
Practice Address - Phone:832-321-4076
Practice Address - Fax:832-321-4080
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT011703207X00000X
FLOS11195207X00000X
TXP2409207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14CN1OtherBCBS
FL003735000Medicaid
FL433915OtherAVMED
FL9208722OtherAETNA
FLFF336ZMedicare PIN