Healthcare Provider Details

I. General information

NPI: 1932887676
Provider Name (Legal Business Name): SAMUEL D. CRITIDES, JR., M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350G RACETRACK RD NW
FORT WALTON BEACH FL
32547-1699
US

IV. Provider business mailing address

350G RACETRACK RD NW
FORT WALTON BEACH FL
32547-1699
US

V. Phone/Fax

Practice location:
  • Phone: 850-374-3125
  • Fax: 850-226-5544
Mailing address:
  • Phone: 850-374-3125
  • Fax: 850-226-5544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL D CRITIDES JR.
Title or Position: OWNER/ P, S
Credential: MD
Phone: 850-374-3125