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General NPI Number Information
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NPI Number | 1700920725
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Entity Type | Organization
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Legal Business Name | DR. BRUCE S. SAMUELS, LLC
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 06/07/2013
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Provider Practice Location Address
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Address Line | 189 GREENBRIAR BLVD SUITE C
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City | COVINGTON
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State | LA
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Zip | 70433-7234
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Country | US
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Telephone | 985-871-8920
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Fax | 985-871-9796
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Provider Business Mailing Address
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Address Line | PO BOX 1847
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City | COVINGTON
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State | LA
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Zip | 70434-1847
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Country | US
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Telephone | 985-871-4910
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Fax | 985-871-9796
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Authorized Official
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Title or Position | ADMIN. ASST.
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Name | CHERYL PEREZ
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Credential |
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Telephone | 985-871-4910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 013678
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 012831
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License Number State | LA
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