Healthcare Provider Details

I. General information

NPI: 1740590751
Provider Name (Legal Business Name): BIENVENIDO M. SAMERA, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2010
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 SUWANNEE AVE NW
BRANFORD FL
32008-3275
US

IV. Provider business mailing address

PO BOX 846
BRANFORD FL
32008-0846
US

V. Phone/Fax

Practice location:
  • Phone: 386-935-1093
  • Fax: 386-935-3113
Mailing address:
  • Phone: 386-935-1093
  • Fax: 386-935-3113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0028682
License Number StateFL

VIII. Authorized Official

Name: DR. BIENVENIDO M SAMERA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 386-935-1093