Provider Demographics
NPI:1679513923
Name:ELGHOR, SAM M (MD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:M
Last Name:ELGHOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:804 23RD ST S
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4705
Mailing Address - Country:US
Mailing Address - Phone:320-230-7788
Mailing Address - Fax:320-230-7789
Practice Address - Street 1:804 23RD ST S
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4705
Practice Address - Country:US
Practice Address - Phone:320-230-7788
Practice Address - Fax:320-230-7789
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN42871208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN42871OtherMN LICENSE