Provider Demographics
NPI:1073672754
Name:HAMRA, SAM T (MD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:T
Last Name:HAMRA
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 1:2731 LEMMON AVE E STE 306
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2841
Mailing Address - Country:US
Mailing Address - Phone:214-754-9001
Mailing Address - Fax:
Practice Address - Street 1:2731 LEMMON AVE E STE 306
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-2841
Practice Address - Country:US
Practice Address - Phone:214-754-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1606174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00P-287OtherBCBS PROVIDER NUMBER
TXAH5682984OtherDEA
TX00P-287OtherBCBS PROVIDER NUMBER