Provider Demographics
NPI:1437119864
Name:ORR, SAMUEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:R
Last Name:ORR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3901 CENTRAL PIKE
Mailing Address - Street 2:SUITE 251
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-3419
Mailing Address - Country:US
Mailing Address - Phone:615-232-8033
Mailing Address - Fax:615-885-7838
Practice Address - Street 1:920 S HARTMANN DR STE 200
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-4018
Practice Address - Country:US
Practice Address - Phone:615-466-9770
Practice Address - Fax:615-466-9782
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK9376208000000X
TN49814208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1441099-02OtherCSHCN
TNQ000548Medicaid
TX1441099-01Medicaid
TX370018989OtherRR/MEDICARE
TN49814OtherSTATE LICENSE
TX8B0916OtherBLUE SHIELD
TX8B0916OtherBLUE SHIELD
TX1441099-01Medicaid