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Individual

DR. SAMUEL S DIVAKER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
6551 N ORANGE BLOSSOM TRL STE 229, MOUNT DORA, FL 32757-7018
(352) 383-8384
(678) 553-0329
Mailing address
13506 SUMMERPORT VILLAGE PKWY # 334, WINDERMERE, FL 34786-7366
(407) 615-5005
(678) 553-0329

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD90893
FL
208000000X
Pediatrics Physician
ME90893
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
270372600
FL
Enumeration date
09/26/2006
Last updated
06/07/2021
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