Healthcare Provider Details

I. General information

NPI: 1013117498
Provider Name (Legal Business Name): ADAM SAMARITONI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 HOSPITAL DR FAMILY MEDICINE
HANNIBAL MO
63401-6890
US

IV. Provider business mailing address

6500 HOSPITAL DR FAMILY MEDICINE
HANNIBAL MO
63401-6890
US

V. Phone/Fax

Practice location:
  • Phone: 573-629-3440
  • Fax: 573-629-3415
Mailing address:
  • Phone: 573-629-3440
  • Fax: 573-629-3415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2010010945
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: