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NPI Code Detail

MEDICARE: DR. JEFFREY NEIL SAMUELSON M.D.

MEDICARE: DR. JEFFREY NEIL SAMUELSON M.D.
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
1207N00000XDermatology Physician40515MN
2207ND0101XMOHS-Micrographic Surgery Physician40515MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407912678
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY NEIL SAMUELSON M.D.
Provider Business Mailing Address
First Line : 1414 WOODLAND AVE
Second Line :
City : DULUTH
State : MN
Zip : 55803-2624
Country : US
Telephone Number : 952-898-1600
Fax Number :
Provider Business Practice Location Address
First Line : 1414 WOODLAND AVE
Second Line :
City : DULUTH
State : MN
Zip : 55803-2624
Country : US
Telephone Number : 218-302-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2006
Last Update Date : 10/13/2020

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