Provider Demographics
NPI:1730222662
Name:MYLES RUBIN SAMOTIN MD PA
Entity type:Organization
Organization Name:MYLES RUBIN SAMOTIN MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MYLES
Authorized Official - Middle Name:RUBIN
Authorized Official - Last Name:SAMOTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-514-4200
Mailing Address - Street 1:9240 BONITA BEACH RD SE STE 2200
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4251
Mailing Address - Country:US
Mailing Address - Phone:239-514-4200
Mailing Address - Fax:239-514-3373
Practice Address - Street 1:9240 BONITA BEACH RD SE STE 2200
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4251
Practice Address - Country:US
Practice Address - Phone:239-514-4200
Practice Address - Fax:239-514-3373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG50737Medicare UPIN
FL1233350001Medicare NSC
FLK0943Medicare PIN