Provider Demographics
NPI:1528367158
Name:SAM E SATO, MD,PC
Entity Type:Organization
Organization Name:SAM E SATO, MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:SATO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-323-2466
Mailing Address - Street 1:3910 N CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1428
Mailing Address - Country:US
Mailing Address - Phone:520-323-2466
Mailing Address - Fax:520-323-2968
Practice Address - Street 1:3910 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-1428
Practice Address - Country:US
Practice Address - Phone:520-323-2466
Practice Address - Fax:520-323-2968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14768207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ247751Medicaid
AZ247751Medicaid