Provider Demographics
NPI:1235144825
Name:CARGILL, SAMUEL E (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:E
Last Name:CARGILL
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 1:1818 COLE ST
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-3504
Mailing Address - Country:US
Mailing Address - Phone:360-802-5760
Mailing Address - Fax:360-802-5799
Practice Address - Street 1:1818 COLE ST
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-3504
Practice Address - Country:US
Practice Address - Phone:360-802-5760
Practice Address - Fax:360-802-5799
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00030972208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA20042177OtherMEDICARE RAILROAD
WA8147761Medicaid
WA126528OtherSTATE L&I
WA100012521OtherMEDICARE RAILROAD
WA126673OtherSTATE L&I
WAGAB08518Medicare PIN
WA8147761Medicaid
WAE70932Medicare UPIN
WAGAB08502Medicare PIN
WA100012521OtherMEDICARE RAILROAD
WA126673OtherSTATE L&I