Provider Demographics
NPI:1861447898
Name:SAM, JOSEPH WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WILLIAM
Last Name:SAM
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:PO BOX 1535
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98401-1535
Mailing Address - Country:US
Mailing Address - Phone:253-761-4200
Mailing Address - Fax:253-383-3553
Practice Address - Street 1:1304 FAWCETT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1911
Practice Address - Country:US
Practice Address - Phone:253-761-4200
Practice Address - Fax:253-383-3553
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000476902085R0202X
FLME853302085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
7368368OtherAETNA HMO
FLME85330OtherFLORIDA LICENSE
WA0249529OtherLABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST
FL264605600Medicaid
WA8943620OtherLABOR AND INDUSTRIES CRIME VICTIMS-TRA
WA8951856OtherLABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST
17219OtherBCBS
WAP00428604OtherRR MEDICARE-TRA
WA8943621OtherLABOR AND INDUSTRIES CRIME VICTIMS-UNION AVENUE OPEN MRI
WA0217647OtherLABOR AND INDUSTRIES-UNION AVENUE OPEN MRI
WA0217648OtherLABOR AND INDUSTRIES-TRA
2845690OtherAETNA PPO
7368368OtherAETNA HMO
WAP00428604OtherRR MEDICARE-TRA
2845690OtherAETNA PPO
H47705Medicare UPIN
WAG8887144Medicare PIN
WAG8865648Medicare PIN
WAG8900023Medicare PIN
WAG8902446Medicare PIN
FL17219ZMedicare ID - Type UnspecifiedFLORIDA MEDICARE
WAG8865646Medicare PIN