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General NPI Number Information
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NPI Number | 1437252780
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Entity Type | Individual
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Provider Name | SAMUEL C POLK M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 7900 AIRWAYS BLVD STE 2
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City | SOUTHAVEN
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State | MS
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Zip | 38671-4113
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Country | US
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Telephone | 601-420-2040
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Fax | 855-343-5763
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Provider Business Mailing Address
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Address Line | PO BOX 649113
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City | DALLAS
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State | TX
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Zip | 75264-9113
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Country | US
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Telephone | 903-571-3844
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Fax | 855-343-5763
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 41433
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 34003
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 34003
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License Number State | MS
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