| Samuel Walters D.o.,p.a. | |
|
6531 103rd St Jacksonville FL 32210-7131 | |
| (904) 772-2727 | |
| (904) 772-1693 |
| Full Name | Samuel Walters D.o.,p.a. |
|---|---|
| Speciality | Clinic/Center |
| Location | 6531 103rd St, Jacksonville, Florida |
| Authorized Official Name and Position | Samuel Walters (CEO/PHYSICIAN) |
| Authorized Official Contact | 9047722727 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Samuel Walters D.o.,p.a. 6531 103rd St Jacksonville FL 32210-7131 Ph: (904) 772-2727 | Samuel Walters D.o.,p.a. 6531 103rd St Jacksonville FL 32210-7131 Ph: (904) 772-2727 |
| NPI Number | 1285966499 |
|---|---|
| Provider Enumeration Date | 02/12/2010 |
| Last Update Date | 07/03/2010 |
| Medicare PECOS PAC ID | 4082749395 |
|---|---|
| Medicare Enrollment ID | O20100311000727 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285966499 | NPI | - | NPPES |
| 261008600 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | OS8337 (Florida) | Primary |
| Provider Name | Samuel Walters |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336119817 PECOS PAC ID: 1355535204 Enrollment ID: I20101104000497 |
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