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General NPI Number Information
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NPI Number | 1780924258
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Entity Type | Individual
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Provider Name | SAMUEL TERRELL BERNARD CSFA
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Gender | Male
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Dates
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Enumeration Date | 02/21/2013
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Last Update Date | 02/21/2013
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Provider Practice Location Address
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Address Line | 7048 69TH ST N
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City | PINELLAS PARK
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State | FL
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Zip | 33781-3930
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Country | US
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Telephone | 727-417-0355
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2814
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City | PINELLAS PARK
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State | FL
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Zip | 33780-2814
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Country | US
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Telephone | 727-417-0355
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 139299
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License Number State |
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