Provider Demographics
NPI:1760542542
Name:SAMMY LERMA III MD PA
Entity Type:Organization
Organization Name:SAMMY LERMA III MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LERMA
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:512-321-3311
Mailing Address - Street 1:PO BOX 664
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-0664
Mailing Address - Country:US
Mailing Address - Phone:512-321-3311
Mailing Address - Fax:512-321-2611
Practice Address - Street 1:1109 CHURCH ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3206
Practice Address - Country:US
Practice Address - Phone:512-321-3311
Practice Address - Fax:512-321-2611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6375207Q00000X
207Q00000X, 207Q00000X
TX617058363LF0000X
TX791283363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080698601Medicaid
TX080698602Medicaid
TX080698603Medicaid
TXDB6623OtherRAILROAD MEDICARE
TX00503NMedicare PIN