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General NPI Number Information
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NPI Number | 1356580567
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Entity Type | Organization
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Legal Business Name | JACOB A SAMANDER MD PA
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Dates
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Enumeration Date | 02/11/2009
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Last Update Date | 07/29/2009
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Provider Practice Location Address
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Address Line | 1401 SE GOLDTREE DR STE 104
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-7584
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Country | US
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Telephone | 772-905-8531
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Fax | 772-905-8526
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Provider Business Mailing Address
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Address Line | PO BOX 882076
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City | PORT ST LUCIE
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State | FL
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Zip | 34988-2076
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Country | US
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Telephone | 772-905-8531
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Fax | 772-905-8526
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACOB A SAMANDER
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Credential | MD
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Telephone | 772-905-8531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME0063339
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License Number State | FL
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