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
Phone: (480) 646-8660
Fax: (480) 646-8665
Website:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1962420315 | NPPES |
| Arizona | Other | 11458639 | CAQH |
| Arizona | MEDICAID | 117012 | CAQH |
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