Provider Demographics
NPI:1730276783
Name:JEAN, SAMUEL (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:JEAN
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 WEKIVA SPRINGS RD
Mailing Address - Street 2:SUITE 231
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-3684
Mailing Address - Country:US
Mailing Address - Phone:407-960-6075
Mailing Address - Fax:888-622-0903
Practice Address - Street 1:365 WEKIVA SPRINGS RD
Practice Address - Street 2:SUITE 231
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-3684
Practice Address - Country:US
Practice Address - Phone:407-960-6075
Practice Address - Fax:888-622-0903
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98157207R00000X, 208M00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279203600Medicaid
FL1730276783Medicare Oscar/Certification
FL1730276783Medicare PIN
FL7529880001Medicare NSC