MEDICARE: SAMUEL L. MCLEOD III MD

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	207V00000X	Obstetrics & Gynecology Physician	ME39837	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336130335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL L. MCLEOD III MD

Provider Business Mailing Address
First Line	:	2931 CULLEN LAKE SHORE DR.
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812
Country	:	US
Telephone Number	:	407-616-3404
Fax Number	:	407-857-7277

Provider Business Practice Location Address
First Line	:	2931 CULLEN LAKE SHORE DR.
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812
Country	:	US
Telephone Number	:	407-616-3404
Fax Number	:	407-857-7277

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	09/02/2016

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