Healthcare Provider Details

I. General information

NPI: 1093907750
Provider Name (Legal Business Name): SAMUEL J. KASBERG, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 KNICKERBOCKER RD
SAN ANGELO TX
76904-7610
US

IV. Provider business mailing address

223 S ABE ST
SAN ANGELO TX
76903-6305
US

V. Phone/Fax

Practice location:
  • Phone: 325-949-9511
  • Fax: 325-655-7976
Mailing address:
  • Phone: 325-655-7969
  • Fax: 325-655-7976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberJ3826
License Number StateTX

VIII. Authorized Official

Name: SAMUEL JOSEPH KASBERG
Title or Position: PHYSICIAN/CEO
Credential: M.D.
Phone: 325-655-7969