=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467678029
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID E. SAMARA, M.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3801 W 15TH ST SUITE #D-120
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75075-4737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-519-0545
-----------------------------------------------------
Fax | 972-964-0563
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 260877
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75026-0877
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-519-0545
-----------------------------------------------------
Fax | 972-612-7117
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | KELLE MAYNARD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-519-0545
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------