Provider Demographics
NPI:1407883820
Name:ABSHIRE, SAMUEL K (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:K
Last Name:ABSHIRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:926 FRANCES DR
Mailing Address - Street 2:
Mailing Address - City:HAYNESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71038-6100
Mailing Address - Country:US
Mailing Address - Phone:318-624-0554
Mailing Address - Fax:318-624-3782
Practice Address - Street 1:926 FRANCES DR
Practice Address - Street 2:
Practice Address - City:HAYNESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71038-6100
Practice Address - Country:US
Practice Address - Phone:318-624-0554
Practice Address - Fax:318-624-3782
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016313207QA0401X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1336491Medicaid
AR110320001Medicaid
LA50348DB47Medicare PIN
LA1336491Medicaid
LAB62336Medicare UPIN
LA50348C739Medicare UPIN
LA50348B579Medicare Oscar/Certification
LA50348C739Medicare Oscar/Certification
LA50348B579Medicare PIN