Provider Demographics
NPI:1073588000
Name:ST CLAIR, SAMUEL K (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:K
Last Name:ST CLAIR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4201 LAKE BOONE TRL
Mailing Address - Street 2:STE 202
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7512
Mailing Address - Country:US
Mailing Address - Phone:919-235-0500
Mailing Address - Fax:919-235-0505
Practice Address - Street 1:4207 LAKE BOONE TRL STE 220
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6685
Practice Address - Country:US
Practice Address - Phone:919-784-1410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC39097207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC56219447701OtherTRICARE
NC8979535Medicaid
NC97486OtherMEDCOST
NC706943OtherCHOICE CARE NETWORK
NC79535OtherBCBS NC
NC2070150OtherFIRST HEALTH
NC0650385OtherUNITED HEALTHCARE
NC4063806OtherAETNA
NC140006908OtherRAILROAD MEDICARE
NC706943OtherCHOICE CARE NETWORK