Healthcare Provider Details

I. General information

NPI: 1518936236
Provider Name (Legal Business Name): KATHLEEN M SAMSEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 ROGER BROOKE DR
FORT SAM HOUSTON TX
78234-6200
US

IV. Provider business mailing address

3551 ROGER BROOKE DR
JBSA FSH TX
78234-4504
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-1006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01061648A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberM7591
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: