Provider Demographics
NPI:1982622056
Name:SAMUEL, FELICE J (MD)
Entity Type:Individual
Prefix:
First Name:FELICE
Middle Name:J
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 W CAMINO REAL
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5510
Mailing Address - Country:US
Mailing Address - Phone:561-465-2598
Mailing Address - Fax:561-465-2599
Practice Address - Street 1:7100 W CAMINO REAL
Practice Address - Street 2:SUITE 301
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5510
Practice Address - Country:US
Practice Address - Phone:561-465-2598
Practice Address - Fax:561-465-2599
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66308207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31672OtherBXBS FL
FL251213100Medicaid
FLF37246Medicare UPIN
FL31672ZMedicare PIN