Provider Demographics
NPI:1033199963
Name:NAVA, SAMUEL JR (DPM)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:NAVA
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4333 N JOSEY LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4629
Mailing Address - Country:US
Mailing Address - Phone:972-394-0825
Mailing Address - Fax:972-394-0853
Practice Address - Street 1:4333 N JOSEY LN
Practice Address - Street 2:SUITE 102
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4629
Practice Address - Country:US
Practice Address - Phone:972-394-0825
Practice Address - Fax:972-394-0853
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1241213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000880211OtherDPS
TX121580801Medicaid
TXBN4591182OtherDEA
TX121580801Medicaid
TX8L17772Medicare PIN
TX8792J1Medicare PIN
TXBN4591182OtherDEA
TX4600300005Medicare NSC