MEDICARE: SAMUEL E. MYRICK, JR., 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
1	207PE0005X	Undersea and Hyperbaric Medicine (Emergency Medicine) Physician

General Provider Information

NPI Number	:	1447290812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMUEL E. MYRICK, JR., M.D.

Provider Business Mailing Address
First Line	:	PO BOX 552254
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33655-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 UNIVERSITY BLVD S
Second Line	:	SUITE 221
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4377
Country	:	US
Telephone Number	:	904-421-2119
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SAMUEL MYRICK JR.
Credential	:	MD
Telephone Number	:	904-421-2119

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	07/25/2007

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