Provider Demographics
NPI:1952969966
Name:SAMORA-DIETZ, TAYLOR JOSEPH (DO)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:JOSEPH
Last Name:SAMORA-DIETZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 808 BOX 19
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09618-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:U.S. NAVAL HOSPITAL
Practice Address - Street 2:
Practice Address - City:GRICIGNANO DI AVERSA
Practice Address - State:CE
Practice Address - Zip Code:81030
Practice Address - Country:IT
Practice Address - Phone:081-811-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102206227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVAD0000OtherMILITARY PHYSICIANS