Provider Demographics
NPI:1720703846
Name:DANKERT, SAMSON WILLIAM (PA-C)
Entity type:Individual
Prefix:
First Name:SAMSON
Middle Name:WILLIAM
Last Name:DANKERT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 E MARCH LN STE C
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-5625
Mailing Address - Country:US
Mailing Address - Phone:209-227-5052
Mailing Address - Fax:
Practice Address - Street 1:1507 E MARCH LN STE C
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-5625
Practice Address - Country:US
Practice Address - Phone:209-227-5052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62176363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty