Healthcare Provider Details

I. General information

NPI: 1174583215
Provider Name (Legal Business Name): KALA G SAMPAT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 W 1ST ST SUITE B
BORGER TX
79007-4001
US

IV. Provider business mailing address

503 W 1ST ST SUITE B
BORGER TX
79007-4001
US

V. Phone/Fax

Practice location:
  • Phone: 806-274-7111
  • Fax: 806-274-7113
Mailing address:
  • Phone: 806-274-7111
  • Fax: 806-274-7113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberF0661
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: