Provider Demographics
NPI:1881682912
Name:SAMORA, PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:SAMORA
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 1:1414 LUISA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4347
Mailing Address - Country:US
Mailing Address - Phone:505-930-5040
Mailing Address - Fax:505-930-5041
Practice Address - Street 1:465 SAINT MICHAELS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7670
Practice Address - Country:US
Practice Address - Phone:505-995-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2007-0786207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00082076OtherTRAVELERS MEDICARE
COSA666518OtherANTHEM BCBS
46682040OtherNEW MEXICO MEDICAID
CO840706945159OtherROCKY MOUNTAIN HEALH PLAN
CO59577754Medicaid
COSA666518OtherANTHEM BCBS
CO59577754Medicaid