=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699179390
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAM T. HAMRA M.D. P. A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2014
-----------------------------------------------------
Last Update Date | 10/09/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4131 N CENTRAL EXPY # 950
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75204-2102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-754-9001
-----------------------------------------------------
Fax | 214-754-9080
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4131 N CENTRAL EXPY # 950
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75204-2102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-754-9001
-----------------------------------------------------
Fax | 214-754-9080
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SAM T HAMRA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 214-754-9001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0122X
-----------------------------------------------------
Taxonomy Name | Plastic and Reconstructive Surgery Physician
-----------------------------------------------------
License Number | E1606
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------