MEDICARE: DR. SAMUEL MOWERMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME97219	FL
2	2084P0804X	Child & Adolescent Psychiatry Physician	ME97219	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	102436	OTHER	NY	LICENSE
3	ME97219	OTHER	LA	LICENSE

General Provider Information

NPI Number	:	1255400602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL MOWERMAN MD

Provider Business Mailing Address
First Line	:	1065 NE 125 ST
Second Line	:	STE 409
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161
Country	:	US
Telephone Number	:	888-852-6672
Fax Number	:	305-891-4228

Provider Business Practice Location Address
First Line	:	1065 NE 125 ST
Second Line	:	STE 206
City	:	N MIAMI
State	:	FL
Zip	:	33161
Country	:	US
Telephone Number	:	888-852-6672
Fax Number	:	305-891-4228

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	02/13/2014

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