Healthcare Provider Details

I. General information

NPI: 1407558984
Provider Name (Legal Business Name): SAMUEL HADDAD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 DOUGLAS AVE
ALTAMONTE SPRINGS FL
32714-3335
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

V. Phone/Fax

Practice location:
  • Phone: 407-788-8200
  • Fax: 407-788-3746
Mailing address:
  • Phone: 844-630-0700
  • Fax: 877-374-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS23969
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: