Individual
RAVI SAMLAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
12470 TELECOM DR STE 300W, TEMPLE TERRACE, FL 33637-0904
(813) 871-8200
(813) 357-5501
Mailing address
12470 TELECOM DR STE 300W, TEMPLE TERRACE, FL 33637-0904
(813) 871-8200
(813) 357-5501
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
OS11781
FL
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
OS11781
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
012540200
—
FL
01
—
14W85
BCBS
FL
01
—
OS11781
FL LICENSE
FL
01
—
P01768777
RAILROAD MEDICARE
FL
Enumeration date
07/27/2010
Last updated
03/07/2023
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