=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912318783
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAM VALID MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2014
-----------------------------------------------------
Last Update Date | 04/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 ROCKEFELLER DR
-----------------------------------------------------
City | MUSKOGEE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74401-5075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-502-1900
-----------------------------------------------------
Fax | 918-494-6303
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 420 E DIVISION ST
-----------------------------------------------------
City | FOND DU LAC
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54935-4560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-926-8343
-----------------------------------------------------
Fax | 920-926-8370
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 52607
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | 2017031843
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | 01077214A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | 64288 - 2
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 37100
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------