Provider Demographics
NPI:1023389673
Name:BOOR, SAMUEL VLADIMIR (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:VLADIMIR
Last Name:BOOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 TRAPPER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-8126
Mailing Address - Country:US
Mailing Address - Phone:406-761-2221
Mailing Address - Fax:406-761-2221
Practice Address - Street 1:15 TRAPPER VALLEY RD
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-8126
Practice Address - Country:US
Practice Address - Phone:406-761-2221
Practice Address - Fax:406-761-2221
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4717207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine