Provider Demographics
NPI:1487659298
Name:SASSER, SAM MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:MICHAEL
Last Name:SASSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1762 E MCANDREWS RD
Mailing Address - Street 2:STE D
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5577
Mailing Address - Country:US
Mailing Address - Phone:541-779-4385
Mailing Address - Fax:541-779-5275
Practice Address - Street 1:1762 E MCANDREWS RD
Practice Address - Street 2:STE D
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5577
Practice Address - Country:US
Practice Address - Phone:541-779-4385
Practice Address - Fax:541-779-5275
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD97042084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORE20620Medicare UPIN
0000BHJFSMedicare ID - Type Unspecified