MEDICARE: SAMUEL M. HOPKINS 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	ME32777	FL

General Provider Information

NPI Number	:	1336137975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL M. HOPKINS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 915389
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32791-5389
Country	:	US
Telephone Number	:	407-875-8784
Fax Number	:

Provider Business Practice Location Address
First Line	:	136 PARLIAMENT LOOP
Second Line	:	SUITE 102
City	:	LAKE MARY
State	:	FL
Zip	:	32746-3531
Country	:	US
Telephone Number	:	407-333-0160
Fax Number	:	407-333-0108

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

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	05/22/2008

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