MEDICARE: SAMANTHA JEAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	52119	KY
2	208M00000X	Hospitalist Physician	336250	LA
3	208M00000X	Hospitalist Physician	ME132410	FL
4	208M00000X	Hospitalist Physician	52119	KY
5	207Q00000X	Family Medicine Physician	ME132410	FL

General Provider Information

NPI Number	:	1023438512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA JEAN M.D.

Provider Business Mailing Address
First Line	:	2525 HARBOR BLVD
Second Line	:	SUITE 308
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952
Country	:	US
Telephone Number	:	419-629-7777
Fax Number	:	941-629-8170

Provider Business Practice Location Address
First Line	:	2525 HARBOR BLVD
Second Line	:	SUITE 308
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952
Country	:	US
Telephone Number	:	419-629-7777
Fax Number	:	941-629-8170

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2014
Last Update Date	:	06/09/2026

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