Provider Demographics
NPI:1760608798
Name:SAMARA, DAFER M (MD)
Entity Type:Individual
Prefix:DR
First Name:DAFER
Middle Name:M
Last Name:SAMARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 CARONDELET DR STE 300
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4858
Mailing Address - Country:US
Mailing Address - Phone:816-943-4200
Mailing Address - Fax:
Practice Address - Street 1:1004 CARONDELET DR STE 300
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4858
Practice Address - Country:US
Practice Address - Phone:816-942-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA38048207R00000X, 207RC0200X, 207RP1001X
MO2015019906207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00741089OtherRR MEDICARE
IA1760608798Medicaid
IAP00741089OtherRR MEDICARE