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General NPI Number Information
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NPI Number | 1497041008
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Entity Type | Organization
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Legal Business Name | DAVID L. SAMUEL, M.D. A PROFFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 06/22/2011
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Last Update Date | 06/22/2011
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Provider Practice Location Address
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Address Line | 233 SAINT ANN DR SUITE 3
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City | MANDEVILLE
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State | LA
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Zip | 70471-3395
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Country | US
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Telephone | 985-624-6650
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Fax | 985-674-3634
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Provider Business Mailing Address
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Address Line | 233 SAINT ANN DR SUITE 3
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City | MANDEVILLE
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State | LA
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Zip | 70471-3395
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Country | US
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Telephone | 985-624-6650
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Fax | 985-674-3634
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Authorized Official
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Title or Position | M.D.
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Name | DR. DAVID L SAMUEL
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Credential | M.D.
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Telephone | 985-624-6650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 10711R
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License Number State | LA
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