Basic Information
| Provider Information | |||||||||
| NPI: | 1699902486 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAMUEL | ||||||||
| FirstName: | ADAM | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3488 DEPT 05-039 | ||||||||
| Address2: | |||||||||
| City: | TUPELO | ||||||||
| State: | MS | ||||||||
| PostalCode: | 388033488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183003643 | ||||||||
| FaxNumber: | 8885114191 | ||||||||
| Practice Location | |||||||||
| Address1: | 1514 JEFFERSON HWY | ||||||||
| Address2: | BH 634 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701212429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048423000 | ||||||||
| FaxNumber: | 5048422036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2009 | ||||||||
| LastUpdateDate: | 01/31/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | LA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207L00000X | MD.203916 | LA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.