Provider Demographics
NPI:1447246202
Name:ABUERREISH, SAMEH G (MD)
Entity Type:Individual
Prefix:
First Name:SAMEH
Middle Name:G
Last Name:ABUERREISH
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 1:400 SOUTH 15TH STREET
Mailing Address - Street 2:
Mailing Address - City:WORLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82401
Mailing Address - Country:US
Mailing Address - Phone:307-347-5810
Mailing Address - Fax:307-347-5808
Practice Address - Street 1:400 SOUTH 15TH STREET
Practice Address - Street 2:
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401
Practice Address - Country:US
Practice Address - Phone:307-347-5810
Practice Address - Fax:307-347-5808
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01049240A207RH0003X
WV23034207RH0003X
KS0434951207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB4231761Medicare PIN
P00608531Medicare PIN