Healthcare Provider Details

I. General information

NPI: 1912971979
Provider Name (Legal Business Name): SAMUEL S WOOCIKER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 S ORANGE AVE SUITE 100
ORLANDO FL
32806-3069
US

IV. Provider business mailing address

445 WARRIOR TRL
ENTERPRISE FL
32725-2456
US

V. Phone/Fax

Practice location:
  • Phone: 407-423-1234
  • Fax: 407-517-1040
Mailing address:
  • Phone: 407-376-0522
  • Fax: 407-386-3077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO 1323
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: