Basic Information
| Provider Information | |||||||||
| NPI: | 1295953008 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALFORD-MORALES | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ALFORD | ||||||||
| OtherFirstName: | SAMANTHA | ||||||||
| OtherMiddleName: | C | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 38754 STATE ROAD 80 | ||||||||
| Address2: | |||||||||
| City: | BELLE GLADE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334305615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619961600 | ||||||||
| FaxNumber: | 5618375332 | ||||||||
| Practice Location | |||||||||
| Address1: | 38754 STATE ROAD 80 | ||||||||
| Address2: | |||||||||
| City: | BELLE GLADE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334305615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619961600 | ||||||||
| FaxNumber: | 5618375332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2007 | ||||||||
| LastUpdateDate: | 12/21/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | ME92101 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 277981100 | 05 | FL | MEDICAID | 95097 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER |