MEDICARE: SAMER M. NACHAWATI, LLC

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
1	207R00000X	Internal Medicine Physician	Q9689	TX

General Provider Information

NPI Number	:	1740717545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMER M. NACHAWATI, LLC

Provider Business Mailing Address
First Line	:	1817 INDEPENDENCE CT
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-1914
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1817 INDEPENDENCE CT
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-1914
Country	:	US
Telephone Number	:	214-535-7892
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. SAMER NACHAWATI
Credential	:	D.O.
Telephone Number	:	214-535-7892

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	05/11/2017

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