Provider Demographics
NPI:1760485817
Name:MORAN, SAM HOUSTON (MD)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:HOUSTON
Last Name:MORAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 440222
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244-0222
Mailing Address - Country:US
Mailing Address - Phone:615-329-9333
Mailing Address - Fax:615-329-0222
Practice Address - Street 1:329 21ST AVE N
Practice Address - Street 2:STE 4
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1838
Practice Address - Country:US
Practice Address - Phone:615-329-9333
Practice Address - Fax:615-329-0222
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN17256207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNA98772Medicare UPIN