Provider Demographics
NPI:1629486154
Name:SIGOLOFF, SAMUEL NELSON (DO)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:NELSON
Last Name:SIGOLOFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7950 MARTIN LOOP
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31905-5648
Mailing Address - Country:US
Mailing Address - Phone:706-544-1554
Mailing Address - Fax:
Practice Address - Street 1:4290 S SILVA DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85650-8830
Practice Address - Country:US
Practice Address - Phone:210-872-1357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1149207Q00000X
TXS3747207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine