Healthcare Provider Details

I. General information

NPI: 1447527478
Provider Name (Legal Business Name): SAMUEL DWIGHT FRANKLIN AP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2011
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 LAKE CENTER DR APT 26105
MOUNT DORA FL
32757-6532
US

IV. Provider business mailing address

3530 LAKE CENTER DR APT 26105
MOUNT DORA FL
32757-6532
US

V. Phone/Fax

Practice location:
  • Phone: 270-339-3299
  • Fax:
Mailing address:
  • Phone: 270-339-3299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number3007
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: