Healthcare Provider Details

I. General information

NPI: 1881682912
Provider Name (Legal Business Name): PATRICK SAMORA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 SAINT MICHAELS DR SUITE 101
SANTA FE NM
87505-7670
US

IV. Provider business mailing address

1414 LUISA ST
SANTA FE NM
87505-4347
US

V. Phone/Fax

Practice location:
  • Phone: 505-995-2400
  • Fax:
Mailing address:
  • Phone: 505-930-5040
  • Fax: 505-930-5041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2007-0786
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: