Provider Demographics
NPI:1831180546
Name:MYRICK, SAMUEL E III (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:E
Last Name:MYRICK
Suffix:III
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 1:3130 SW 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-4445
Mailing Address - Country:US
Mailing Address - Phone:352-732-4032
Mailing Address - Fax:352-732-4191
Practice Address - Street 1:3130 SW 32ND AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4445
Practice Address - Country:US
Practice Address - Phone:352-732-4032
Practice Address - Fax:352-732-4191
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90579207RX0202X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274398100Medicaid
GA522939661AMedicaid
FL48109WMedicare PIN
I23532Medicare UPIN
GA522939661AMedicaid
48109ZMedicare ID - Type Unspecified