Provider Demographics
NPI:1528039732
Name:NOURANI, SAM M (MD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:M
Last Name:NOURANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:655 SIERRA ROSE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2060
Mailing Address - Country:US
Mailing Address - Phone:775-829-7600
Mailing Address - Fax:858-683-0380
Practice Address - Street 1:655 SIERRA ROSE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2060
Practice Address - Country:US
Practice Address - Phone:775-829-7600
Practice Address - Fax:858-683-0380
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84952207RG0300X
NV13331207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A849520Medicaid
CAWA84952AMedicare ID - Type UnspecifiedGROUP# W7168
CA00A849520Medicaid