MEDICARE: DR. SAM DAGGUBATI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	G2678	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00AD18	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	111171100	OTHER	TX	FIRSTCARE

General Provider Information

NPI Number	:	1538179916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAM DAGGUBATI M.D.

Provider Business Mailing Address
First Line	:	1309 HICKORY ST
Second Line	:
City	:	ABILENE
State	:	TX
Zip	:	79601-3509
Country	:	US
Telephone Number	:	325-673-1322
Fax Number	:	325-675-6514

Provider Business Practice Location Address
First Line	:	1309 HICKORY ST
Second Line	:
City	:	ABILENE
State	:	TX
Zip	:	79601-3509
Country	:	US
Telephone Number	:	325-673-1322
Fax Number	:	325-675-6514

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	07/08/2007

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