Samuel Walters D.O.,P.a.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

OS8337 Issued in FL

Legal business name

SAMUEL WALTERS D.O.,P.A.

Practice address

6531 103Rd St
Jacksonville, FL 32210-7131

Phone

(904) 772-2727

Fax

(904) 772-1693

NPI assigned

Feb 12, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Samuel Walters, D.O

Title

Ceo/Physician

Phone

(904) 772-2727

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1265932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278115200000",
    "number": "1285966499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6531 103RD ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322107131",
            "telephone_number": "904-772-2727",
            "fax_number": "904-772-1693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6531 103RD ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322107131",
            "telephone_number": "904-772-2727",
            "fax_number": "904-772-1693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMUEL WALTERS D.O.,P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-12",
        "last_updated": "2010-07-03",
        "status": "A",
        "authorized_official_last_name": "WALTERS",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "CEO/PHYSICIAN",
        "authorized_official_telephone_number": "904-772-2727",
        "authorized_official_credential": "D.O"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "FL",
            "license": "OS8337",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "261008600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan Leanne Samson, M.D.
• Samuel B. Gaskins IV DMD PA
• Samuel D Kulick DPM
• Samuel E. Myrick, Jr., M.D.
• Samuel Hathy III,O.D.
• Angelique Samuel, ARNP
• Ashleigh J Samuel
• Ashley Samuel, DPT
• Florence Gwendolyn Samuel
• John Samuelraj, OTR

• Primary Care Clinic/Center in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Primary Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.