Healthcare Provider Details

I. General information

NPI: 1053577957
Provider Name (Legal Business Name): SAMUEL GILBERT ESPIRITU D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOONE RD
BREMERTON WA
98312-1898
US

IV. Provider business mailing address

1 BOONE RD
BREMERTON WA
98312-1898
US

V. Phone/Fax

Practice location:
  • Phone: 603-475-4416
  • Fax:
Mailing address:
  • Phone: 360-475-4416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0102202459
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number0102202459
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: