Healthcare Provider Details

I. General information

NPI: 1760608798
Provider Name (Legal Business Name): DAFER M SAMARA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 CARONDELET DR STE 300
KANSAS CITY MO
64114-4858
US

IV. Provider business mailing address

1004 CARONDELET DR STE 300
KANSAS CITY MO
64114-4858
US

V. Phone/Fax

Practice location:
  • Phone: 816-942-4500
  • Fax:
Mailing address:
  • Phone: 816-943-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number38048
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number38048
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number2015019906
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number2015019906
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number38048
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: