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Samuel Walters D.O.,p.A.

Clinic/Center, Primary Care in Jacksonville, FL. Organization (NPI-2).

NPI number1285966499
StatusActive
Last updated in NPPESJul 3, 2010

Details

NPI
1285966499
Entity type
Organization (NPI-2)
Legal business name
Samuel Walters D.O.,p.A.
Organization subpart
No
Enumeration date
Feb 12, 2010
Last updated
Jul 3, 2010

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QP2300X Clinic/Center, Primary CareOS8337FLYes

Practice location

6531 103rd St
Jacksonville, FL 32210-7131

Phone 904-772-2727 · Fax 904-772-1693

Mailing address

6531 103rd St
Jacksonville, FL 32210-7131

Phone 904-772-2727 · Fax 904-772-1693

Authorized official

Samuel Walters
Ceo/Physician
9047722727

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