Provider Demographics
NPI:1326151028
Name:SERBIN, SAMSON GARY (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMSON
Middle Name:GARY
Last Name:SERBIN
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 1:6036 NORTH 19TH AVENUE
Mailing Address - Street 2:SUITE 400B
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2110
Mailing Address - Country:US
Mailing Address - Phone:602-242-2520
Mailing Address - Fax:602-242-7625
Practice Address - Street 1:6036 NORTH 19TH AVENUE
Practice Address - Street 2:SUITE 400B
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2110
Practice Address - Country:US
Practice Address - Phone:602-242-2520
Practice Address - Fax:602-242-7625
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ175262086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ122502OtherHEALTHNET
AZ3354946OtherCIGNA
AZ299124-01Medicaid
AZ4062898OtherAETNA
AZAZ0258960OtherBLUE CROSS
AZC46701Medicare UPIN
AZMD17526Medicare ID - Type Unspecified