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General NPI Number Information
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NPI Number | 1306039599
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Entity Type | Organization
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Legal Business Name | GREGORY P. SAMANO D.O., P.A.
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 02/04/2011
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Provider Practice Location Address
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Address Line | 807 STATE ROAD 44
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-7271
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Country | US
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Telephone | 386-428-5554
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Fax | 386-409-7971
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Provider Business Mailing Address
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Address Line | 807 STATE ROAD 44
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-7271
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Country | US
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Telephone | 386-428-5554
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Fax | 386-409-7971
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Authorized Official
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Title or Position | PHYSICIAN
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Name | GREGORY P. SAMANO
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Credential | D.O., P.A.
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Telephone | 386-428-5554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0S3360
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License Number State | FL
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