Healthcare Provider Details

I. General information

NPI: 1720084544
Provider Name (Legal Business Name): EDWARD J. SAMBEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 SW ORTHOPEDIC CT
LAKE CITY FL
32024-0672
US

IV. Provider business mailing address

4500 W NEWBERRY RD
GAINESVILLE FL
32607-2245
US

V. Phone/Fax

Practice location:
  • Phone: 386-755-9215
  • Fax: 386-755-6469
Mailing address:
  • Phone: 352-336-6000
  • Fax: 352-332-0799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME 69652
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: