Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 23587 | OK |
N | 111NI0900X | Internist | 23587 | OK |
Y | 207RA0401X | Internist - Addiction Medicine | 23587 | OK |
NPI | 1831300995 |
---|---|
Provider Name | Dr. Samuel Alan Amen |
First Address | Bradenton, FL 34205-8641 |
Second Address | Bradenton, FL 34205-8641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 12/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200521770A | (05) | OK |