Individual
JIBIN VALIYAVEETTIL SAMUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MBBS
Contact information
Practice address
501 6TH AVE S, ST PETERSBURG, FL 33701-4634
(727) 767-8480
(727) 767-8420
Mailing address
5002 W HOMER AVE, TAMPA, FL 33629
(305) 979-5174
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
ME104317
FL
207LP3000X
Pediatric Anesthesiology Physician
Primary
ME104317
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002338900
—
FL
Enumeration date
04/01/2009
Last updated
01/18/2017
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