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1437252780 NPI number — SAMUEL C POLK M.D.

NPI Number: 1437252780
Health Care Provider/Practitioner: SAMUEL C POLK M.D.

Information about “1437252780” NPI (SAMUEL C POLK M.D.) exists in 1437252780 in HTML format HTML  |  1437252780 in plain Text format TXT  |  1437252780 in PDF (Portable Document Format) PDF  |  1437252780 in an XML format XML  formats.

NPI Number : 1437252780 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1437252780",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "POLK",
    "FirstName": "SAMUEL",
    "MiddleName": "C",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 649113",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DALLAS",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75264-9113",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "903-571-3844",
    "MailingAddressFaxNumber": "855-343-5763",
    "FirstLinePracticeLocationAddress": "7900 AIRWAYS BLVD STE 2",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SOUTHAVEN",
    "PracticeLocationAddressStateName": "MS",
    "PracticeLocationAddressPostalCode": "38671-4113",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "601-420-2040",
    "PracticeLocationAddressFaxNumber": "855-343-5763",
    "EnumerationDate": "09/05/2006",
    "LastUpdateDate": "06/25/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "208100000X",
          "TaxonomyName": "Physical Medicine & Rehabilitation Physician",
          "LicenseNumber": "41433",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2081P2900X",
          "TaxonomyName": "Pain Medicine (Physical Medicine & Rehabilitation) Physician",
          "LicenseNumber": "34003",
          "LicenseNumberStateCode": "MS",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "208100000X",
          "TaxonomyName": "Physical Medicine & Rehabilitation Physician",
          "LicenseNumber": "34003",
          "LicenseNumberStateCode": "MS",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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