Healthcare Provider Details

I. General information

NPI: 1275705949
Provider Name (Legal Business Name): SAMIR TOMAJIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 BROAD AVE SUITE 450
GULFPORT MS
39501-2404
US

IV. Provider business mailing address

PO BOX 1810
GULFPORT MS
39502
US

V. Phone/Fax

Practice location:
  • Phone: 228-867-5127
  • Fax:
Mailing address:
  • Phone: 228-575-1194
  • Fax: 228-575-2917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number22727
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number22727
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: