Provider Demographics
NPI:1992913933
Name:AFSHAR, SAM (MD)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:AFSHAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 4207
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75606-4207
Mailing Address - Country:US
Mailing Address - Phone:903-315-4119
Mailing Address - Fax:903-315-4130
Practice Address - Street 1:2410 ROUND ROCK AVE STE 110
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4019
Practice Address - Country:US
Practice Address - Phone:903-934-5490
Practice Address - Fax:903-934-5493
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN2898207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP1-0026128OtherINSTITUTIONAL PERMIT