SAMUEL E CROCKETT (NPI# 1679517171) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679517171 |
| Entity Type | Individual |
| Full Name | SAMUEL E CROCKETT |
| Credential | MD |
| Practice Address |
2520 N Orange Ave Suite 102 Orlando FL 32804-4638 |
| Practice Telephone | 4073032801 |
| Practice Fax Number | 4073032805 |
| Mailing Telephone | 4073032801 |
| Mailing Fax Number | 4073032805 |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2007-08-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RE0101X |
Internal Medicine Specialization: Endocrinology, Diabetes & Metabolism |
ME31027 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BCBS | 48932 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669448957 | Samuel R. Crockett IIi | Anesthesiology | 1000 E Mountain Blvd, Dept of Anesthesia, Wilkes Barre, PA 18711-0027 | 2006-02-27 |
| Street Address |
2520 N ORANGE AVE SUITE 102 |
| City | ORLANDO |
| State | FL |
| Zip Code | 32804-4638 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255853057 | Chante Perry | Physical Medicine & Rehabilitation | 2520 N Orange Ave, Orlando, FL 32804-4638 | 2017-07-13 |
| 1699812537 | Angela Danielle Mazza | Internal Medicine | 2520 N Orange Ave, #102, Orlando, FL 32804-4638 | 2007-01-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881252716 | Alyssa Bass | Counselor | 3130 Edgewater Dr, Orlando, FL 32804 | 2019-06-05 |
| 1841856366 | Debora Cheryl Ramirez | Technician/Technologist | 1231 North Orange Ave, Orlando, FL 32804 | 2019-05-10 |
| 1679074009 | Jessica Dobbs | Counselor | 3801 Grant Blvd, Orlando, FL 32804 | 2018-02-21 |
| 1881109031 | Pedro Mendez Jr. | Counselor | 1800 W. Colonial Drive, Orlando, FL 32804 | 2017-12-11 |
| 1902259310 | Michael Lo | Nurse Practitioner | 2400 N Orange Ave Ste 302, Orlando, FL 32804 | 2016-07-20 |
| 1083093595 | Michael Gregg | Student in an Organized Health Care Education/Training Program | 2415 North Orange Avenue, Suite 400, Orlando, FL 32804 | 2015-05-29 |
| 1922485473 | Lindsay Rae Piet | Physician Assistant | 1910 N. Orange Ave., Orlando, FL 32804 | 2015-05-05 |
| 1093106189 | College Park Community Acupuncture & Herbal Medicine | Acupuncturist | 710 W. Princeton Street., Suite A, Orlando, FL 32804 | 2015-02-10 |
| 1164822359 | Orlando Sleep Solutions, LLC | Durable Medical Equipment & Medical Supplies | 2921 N. Orange Ave, Orlando, FL 32804 | 2014-08-26 |
| 1780926741 | Joseph Arturo Reza | Student in an Organized Health Care Education/Training Program | 2415 N Orange Ave #400, Orlando, FL 32804 | 2013-03-17 |
| Find all providers in zip 32804 | ||||
| Taxonomy Code | 207RE0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Endocrinology, Diabetes & Metabolism |
| An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437425691 | Vanaja Vijaya Ragavan | Internal Medicine | 12502 Lake Mary Jane Rd, Orlando, FL 32832 | 2012-03-31 |
| 1497988927 | Steven Richard Smith | Internal Medicine | 301 E. Princeston St., Orlando, FL 32804-5546 | 2009-09-01 |
| 1104911452 | Rita Y Rahbany | Internal Medicine | 9166 University Blvd, Orlando, FL 32817-1709 | 2006-10-04 |
| 1295849552 | Tina Kaur Thethi | Internal Medicine | 2415 N Orange Ave Ste 502, Orlando, FL 32804-5503 | 2006-08-17 |
| 1316996325 | Diabetes & Endocrine Center of Orlando, P.a. | Internal Medicine | 3113 Lawton Rd, Suite 100, Orlando, FL 32803-3531 | 2006-05-08 |
| 1558327973 | Sowmya K Suryanarayanan | Internal Medicine | 9975 Tavistock Lakes Blvd Ste 300, Orlando, FL 32827-7665 | 2006-04-25 |
| 1083683106 | Edwin N Lee | Internal Medicine | 7009 Dr Phillips Blvd, Suite 150, Orlando, FL 32819-5123 | 2006-03-14 |
| 1366415978 | Orlando Diabetes and Endocrine Specialists | Internal Medicine | 6150 Metrowest Blvd, Suite 105, Orlando, FL 32835-3290 | 2006-02-13 |
| 1871598128 | Henry Jackson Baskin Sr. | Internal Medicine | 2921 N Orange Ave, Orlando, FL 32804-4627 | 2005-06-14 |
| 1427656016 | Orlando Endocrinology, LLC | Internal Medicine | 11616 Lake Underhill Rd Ste 205, Orlando, FL 32825-4466 | 2020-10-15 |
| Find all providers in ORLANDO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.