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NPI Code Detail

MEDICARE: SAM PETER KOKORIS MD

MEDICARE: SAM PETER KOKORIS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology PhysicianG81519CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100G815190OTHERCABLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578553335
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAM PETER KOKORIS MD
Provider Business Mailing Address
First Line : 4301 NORTHSTAR WAY
Second Line :
City : MODESTO
State : CA
Zip : 95356-9262
Country : US
Telephone Number : 209-342-2300
Fax Number : 209-524-4240
Provider Business Practice Location Address
First Line : 1530 BESSIE AVE
Second Line : STE 108
City : TRACY
State : CA
Zip : 95376-3080
Country : US
Telephone Number : 209-342-2300
Fax Number : 209-524-4240
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2005
Last Update Date : 01/28/2008

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