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General NPI Number Information
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NPI Number | 1720202724
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Entity Type | Organization
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Legal Business Name | BRIAN L SAMUELS MD PLLC
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 700 W IRONWOOD DR
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2656
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Country | US
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Telephone | 208-666-3800
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Fax | 208-666-3833
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Provider Business Mailing Address
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Address Line | PO BOX 339
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City | COEUR D ALENE
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State | ID
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Zip | 83816-0339
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Country | US
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Telephone | 208-666-3800
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Fax | 208-666-3833
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN L SAMUELS
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Credential | MD
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Telephone | 208-666-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | M8989
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License Number State | ID
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