MEDICARE: SAM DEAN

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	347E00000X	Transportation Broker		TX

General Provider Information

NPI Number	:	1881439883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAM DEAN

Provider Business Mailing Address
First Line	:	2959 DONNELL DR
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-5709
Country	:	US
Telephone Number	:	512-500-6939
Fax Number	:

Provider Business Practice Location Address
First Line	:	2959 DONNELL DR
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-5709
Country	:	US
Telephone Number	:	512-500-6939
Fax Number	:

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

Provider Enumeration Date	:	07/01/2024
Last Update Date	:	07/01/2024

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Directions to “ SAM DEAN ” Practice Location

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