DR. JEFFREY NEIL SAMUELSON (NPI# 1407912678) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407912678 |
| Entity Type | Individual |
| Full Name | DR. JEFFREY NEIL SAMUELSON |
| Credential | M.D. |
| Practice Address |
1414 Woodland Ave Duluth MN 55803-2624 |
| Practice Telephone | 2183021000 |
| Mailing Telephone | 9528981600 |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2020-10-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207N00000X | Dermatology | 40515 | MN | Allopathic & Osteopathic Physicians |
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
40515 | MN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 860217400 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649634239 | Jeffrey William Wylie Samuelson | Pharmacy Technician | 2175 Market Street, Unit 122, San Francisco, CA 94114-1477 | 2016-04-08 |
| Street Address |
1414 WOODLAND AVE |
| City | DULUTH |
| State | MN |
| Zip Code | 55803-2624 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639630478 | Amy Larson | Nurse Practitioner | 1414 Woodland Ave, Duluth, MN 55803-2624 | 2019-03-26 |
| 1104340736 | Kaitlyn Bhoopal | Nurse Practitioner | 1414 Woodland Ave, Duluth, MN 55803-2624 | 2017-07-25 |
| 1316348725 | Twin Ports Dermatology Inc | Physician Assistant | 1414 Woodland Ave, Duluth, MN 55803-2624 | 2014-09-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144872615 | Rosslyn Jean Kendrick | Health Educator | 1926 Lakeview Dr, Duluth, MN 55803 | 2019-07-15 |
| 1255757191 | Chandra Rose Shoberg | Physical Therapy Assistant | 131 West Wabasha Street, Duluth, MN 55803 | 2014-03-17 |
| 1053642652 | Kate Elizabeth Matson | Social Worker | 5095 Fish Lake Road, Duluth, MN 55803 | 2010-01-21 |
| 1972740025 | Danie-marie Osterlund | Marriage & Family Therapist | 4321 Allendale Ave., Duluth, MN 55803 | 2009-01-12 |
| 1205020419 | Marjorie Lynn Gilbertson | Registered Nurse | 167 Farley Lane, Duluth, MN 55803 | 2007-08-30 |
| 1497894646 | Jeffrey Keith Somrock | Dentist | 22 E Calvary Rd, Woodland Family Dental Clinic Pa, Duluth, MN 55803 | 2007-02-05 |
| 1407949167 | The Hills Youth and Family Services | Clinic/Center | 4321 Allendale Avenue, Duluth, MN 55803 | 2006-10-02 |
| 1942567086 | Carl Peter Rasmussen | Family Medicine | 1400 Woodland Ave, Duluth, MN 55803 | 2012-04-13 |
| 1285011692 | Chandra J Fischer | Midwife | 3548 W Tischer Rd, Duluth, MN 55803-1124 | 2015-05-05 |
| 1518143999 | Claudia Virginia Weber | Psychologist | 4298 Charles Rd, Duluth, MN 55803-1270 | 2008-01-15 |
| Find all providers in zip 55803 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568766822 | David B Pharis Md PC | Dermatology | 3855 Pleasant Hill Rd, Suite 200, Duluth, GA 30096-1407 | 2010-12-30 |
| 1649264482 | David Blake Pharis | Dermatology | 3855 Pleasant Hill Rd, Suite 200, Duluth, GA 30096-1407 | 2005-09-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770115610 | Dermatology Partners Pllc | Dermatology | 4041 28th St Nw Ste 200, Rochester, MN 55901-7943 | 2020-02-09 |
| 1023460243 | Ji Won Ahn | Dermatology | 200 1st St Sw, Rochester, MN 55905-5902 | 2016-07-12 |
| 1487018263 | Sama Kassira Carley | Dermatology | 200 1st St Sw, Rochester, MN 55905-0001 | 2016-04-07 |
| 1740532340 | Clarus Dermatology Pa | Dermatology | 2603 39th Ave Ne, Suite D-202, Minneapolis, MN 55421-4372 | 2012-10-05 |
| 1598925513 | Ian A Maher | Dermatology | 909 Fulton St Se, Minneapolis, MN 55455 | 2008-06-12 |
| 1235323585 | Bart Theodore Endrizzi | Dermatology | 420 Delaware St Se, Minneapolis, MN 55455-0341 | 2007-08-29 |
| 1730206541 | Michael Robert Campoli | Dermatology | 5200 Fairview Blvd, Wyoming, MN 55092-8013 | 2007-03-25 |
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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.