Healthcare Provider Details

I. General information

NPI: 1336330778
Provider Name (Legal Business Name): SAMUEL ABRAHAM JOSEPH JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MEASE DR
SAFETY HARBOR FL
34695-4659
US

IV. Provider business mailing address

1800 MEASE DR
SAFETY HARBOR FL
34695-4659
US

V. Phone/Fax

Practice location:
  • Phone: 727-669-5300
  • Fax: 727-669-5366
Mailing address:
  • Phone: 727-669-5300
  • Fax: 727-669-5366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME101718
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number243197
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: