Provider Demographics
NPI:1841557345
Name:DVORAK, SAMUEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:C
Last Name:DVORAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1215 DUFF AVENUE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-3014
Mailing Address - Country:US
Mailing Address - Phone:712-792-1500
Mailing Address - Fax:712-792-7597
Practice Address - Street 1:1214 SOUTH GRANT ROAD
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401
Practice Address - Country:US
Practice Address - Phone:712-792-1500
Practice Address - Fax:712-792-7597
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP7903207Q00000X
IA43549207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine