Provider Demographics
NPI:1336130756
Name:SAMARA, ESBER S (MD)
Entity Type:Individual
Prefix:
First Name:ESBER
Middle Name:S
Last Name:SAMARA
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 1:3366 NW EXPRESSWAY
Mailing Address - Street 2:STE 500
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4462
Mailing Address - Country:US
Mailing Address - Phone:405-943-1137
Mailing Address - Fax:405-947-0731
Practice Address - Street 1:3366 NW EXPRESSWAY
Practice Address - Street 2:STE 500
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4462
Practice Address - Country:US
Practice Address - Phone:405-943-1137
Practice Address - Fax:405-947-0731
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9038208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100087660AMedicaid
OK$$$$$$$$$003OtherBC/BS
D35235Medicare UPIN
246707410Medicare PIN
OK$$$$$$$$$003OtherBC/BS