Healthcare Provider Details

I. General information

NPI: 1326673153
Provider Name (Legal Business Name): MR. SAMUEL JEFFREY BAPTISTE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 E LANCE LEAF RD
SPRING TX
77381-2826
US

IV. Provider business mailing address

32 E LANCE LEAF RD
SPRING TX
77381-2826
US

V. Phone/Fax

Practice location:
  • Phone: 340-332-9375
  • Fax:
Mailing address:
  • Phone: 340-332-9375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: