Healthcare Provider Details

I. General information

NPI: 1518150366
Provider Name (Legal Business Name): SAMUEL H DICORTE JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 SEVEN SPRINGS BLVD
NEW PORT RICHEY FL
34655-5643
US

IV. Provider business mailing address

PO BOX 1728
CLEARWATER FL
33757-1728
US

V. Phone/Fax

Practice location:
  • Phone: 727-372-3143
  • Fax: 727-372-3963
Mailing address:
  • Phone: 727-532-0002
  • Fax: 727-532-1318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME103750
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: