Healthcare Provider Details

I. General information

NPI: 1659878205
Provider Name (Legal Business Name): SAMUEL AARON YETZER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TAMPA GENERAL CIR
TAMPA FL
33606-3571
US

IV. Provider business mailing address

1 TAMPA GENERAL CIR
TAMPA FL
33606-3571
US

V. Phone/Fax

Practice location:
  • Phone: 813-635-5817
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME163805
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: