MEDICARE: DR. SAMUEL EFRAIN SANCHEZ D.O.

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	207QG0300X	Geriatric Medicine (Family Medicine) Physician	005911	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780693861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL EFRAIN SANCHEZ D.O.

Provider Business Mailing Address
First Line	:	PO BOX 1775
Second Line	:
City	:	ARIZONA CITY
State	:	AZ
Zip	:	85123-1290
Country	:	US
Telephone Number	:	520-466-5774
Fax Number	:	520-494-0319

Provider Business Practice Location Address
First Line	:	13060 S SUNDLAND GIN
Second Line	:
City	:	ARIZONA CITY
State	:	AZ
Zip	:	85123-1290
Country	:	US
Telephone Number	:	520-466-5774
Fax Number	:	520-494-0319

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

Provider Enumeration Date	:	08/06/2006
Last Update Date	:	04/24/2015

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