Organization
JASON SAMUEL CHARTERED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON T SAMUEL MD (PRESIDENT)
(270) 826-1266
Entity
Organization
Contact information
Practice address
110 THIRD ST, SUITE 310, HENDERSON, KY 42420
(270) 826-1266
(270) 827-5385
Mailing address
PO BOX 1247, HENDERSON, KY 42420
(270) 826-1266
(270) 827-5385
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200893090A
—
IN
05
—
7100038670
—
KY
Enumeration date
11/21/2006
Last updated
05/18/2015
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