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General NPI Number Information
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NPI Number | 1669965976
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Entity Type | Individual
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Provider Name | SAMUEL HARDY THUESON MD
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Gender | Male
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Dates
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Enumeration Date | 06/11/2018
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Last Update Date | 10/13/2026
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Provider Practice Location Address
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Address Line | 31ST MEDICAL GROUP VIA PEDEMONTE, BLDG 121
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City | BASE AMERICANA
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State | AVIANO
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Zip | 33081
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Country | IT
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Telephone |
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Fax |
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Provider Business Mailing Address
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Address Line | 31ST MEDICAL GROUP OPC 103 BOX 49
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City | APO
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State | AE
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Zip | 09604-0049
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0101267947
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License Number State | VA
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