Healthcare Provider Details

I. General information

NPI: 1124102371
Provider Name (Legal Business Name): SAMUEL JOSEPH KASBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 KNICKERBOCKER SAN ANGELO COMMUNITY MEDICAL CENTER
SAN ANGELO TX
76904-7698
US

IV. Provider business mailing address

2438 INDUSTRIAL BLVD PMB 105
ABILENE TX
79605-7207
US

V. Phone/Fax

Practice location:
  • Phone: 325-947-6960
  • Fax: 325-947-6968
Mailing address:
  • Phone: 325-947-6960
  • Fax: 325-947-6968

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:
Title or Position:
Credential:
Phone: