Smith, Sam P

Smith, Sam P is an sole proprietor health care provider with primary practice located at 4915 East Baseline Road Suite 102, Gilbert AZ 85234-2966. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Smith, Sam P can be contacted via phone (480) 646-8660.

Contact Information

Primary practice address
4915 East Baseline Road Suite 102 Gilbert AZ 85234-2966
Fax: (480) 646-8665
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 4237 Arizona

Profile Details

NPI number 1962420315
LBN Legal business name Smith, Sam P
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 17th, 2006
Last updated Aug 16th, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962420315 NPPES
Arizona Other 11458639 CAQH
Arizona MEDICAID 117012 CAQH

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