Healthcare Provider Details

I. General information

NPI: 1548681042
Provider Name (Legal Business Name): SAMUEL THOMAS GATZERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SAM THOMAS GATZERT

II. Dates (important events)

Enumeration Date: 12/31/2013
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 SAINT MICHAEL DR
TEXARKANA TX
75503-2372
US

IV. Provider business mailing address

PO BOX 5667
TEXARKANA TX
75505-5667
US

V. Phone/Fax

Practice location:
  • Phone: 903-223-1014
  • Fax: 903-223-1028
Mailing address:
  • Phone: 903-223-1014
  • Fax: 903-223-1028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number10049245
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberQ6191
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: