Provider Demographics
NPI:1033288121
Name:ROSTAMI, SAM (DO)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:
Last Name:ROSTAMI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:601 CANYON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-3860
Mailing Address - Country:US
Mailing Address - Phone:972-745-7500
Mailing Address - Fax:972-471-0700
Practice Address - Street 1:1017 W HEBRON PKWY
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-1113
Practice Address - Country:US
Practice Address - Phone:972-939-9495
Practice Address - Fax:972-939-0230
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK3273207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine