Provider Demographics
NPI:1326116658
Name:SAMM, PAUL LAURESTON (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:LAURESTON
Last Name:SAMM
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 1:129 SANTA CRUZ COURT
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-8807
Mailing Address - Country:US
Mailing Address - Phone:985-661-9556
Mailing Address - Fax:
Practice Address - Street 1:129 SANTA CRUZ COURT
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8807
Practice Address - Country:US
Practice Address - Phone:985-661-9556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022931207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology