Healthcare Provider Details

I. General information

NPI: 1831106111
Provider Name (Legal Business Name): SAMUEL S MESSIEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SAM S MESSIEH M.D.

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 6TH ST SE
WINTER HAVEN FL
33880-4605
US

IV. Provider business mailing address

1601 6TH ST SE
WINTER HAVEN FL
33880-4605
US

V. Phone/Fax

Practice location:
  • Phone: 863-419-9301
  • Fax: 863-419-9304
Mailing address:
  • Phone: 863-419-9301
  • Fax: 863-419-9304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME-54966
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: