MEDICARE: DR. SAMUEL JEAN MD, MPH

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	207R00000X	Internal Medicine Physician	ME98157	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730276783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL JEAN MD, MPH

Provider Business Mailing Address
First Line	:	365 WEKIVA SPRINGS RD
Second Line	:	SUITE 231
City	:	LONGWOOD
State	:	FL
Zip	:	32779-3684
Country	:	US
Telephone Number	:	407-960-6075
Fax Number	:	888-622-0903

Provider Business Practice Location Address
First Line	:	365 WEKIVA SPRINGS RD
Second Line	:	SUITE 231
City	:	LONGWOOD
State	:	FL
Zip	:	32779-3684
Country	:	US
Telephone Number	:	407-960-6075
Fax Number	:	888-622-0903

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

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	07/21/2022

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