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General NPI Number Information
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NPI Number | 1265614523
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Entity Type | Organization
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Legal Business Name | SAM NAFICY, MD, PS, INC
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 1110 112TH AVE NE SUITE 150
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City | BELLEVUE
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State | WA
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Zip | 98004-4509
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Country | US
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Telephone | 425-450-0880
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Fax | 425-450-0883
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Provider Business Mailing Address
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Address Line | 1110 112TH AVE NE SUITE 150
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City | BELLEVUE
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State | WA
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Zip | 98004-4509
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Country | US
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Telephone | 425-450-0880
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Fax | 425-450-0883
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. SAM NAFICY
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Credential | MD
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Telephone | 425-450-0880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | HC00140296
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License Number State | WA
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