Provider Demographics
NPI:1891787115
Name:GAMBRAH SAMPANEY, ANTHONY O (MD FACP)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:O
Last Name:GAMBRAH SAMPANEY
Suffix:
Gender:M
Credentials:MD FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20477
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77720-0477
Mailing Address - Country:US
Mailing Address - Phone:409-729-7030
Mailing Address - Fax:409-729-7015
Practice Address - Street 1:7980 ANCHOR DR
Practice Address - Street 2:BUILDING 400
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8266
Practice Address - Country:US
Practice Address - Phone:409-729-7030
Practice Address - Fax:409-729-7015
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9675207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143474801Medicaid
TXG19834Medicare UPIN
TX143474801Medicaid
TX110220084Medicare PIN