Provider Demographics
NPI:1235271719
Name:SAMARA, ILONA DOBROWOLSKA (MD)
Entity Type:Individual
Prefix:
First Name:ILONA
Middle Name:DOBROWOLSKA
Last Name:SAMARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 S SARA RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-4303
Mailing Address - Country:US
Mailing Address - Phone:405-578-3250
Mailing Address - Fax:405-578-3299
Practice Address - Street 1:201 S SARA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-4303
Practice Address - Country:US
Practice Address - Phone:405-578-3250
Practice Address - Fax:405-578-3299
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK24606207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine